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Riccardi M, Pagnesi M, Chioncel O, Mebazaa A, Cotter G, Gustafsson F, Tomasoni D, Latronico N, Adamo M, Metra M. Medical therapy of cardiogenic shock: Contemporary use of inotropes and vasopressors. Eur J Heart Fail 2024; 26:411-431. [PMID: 38391010 DOI: 10.1002/ejhf.3162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/23/2024] [Accepted: 01/28/2024] [Indexed: 02/24/2024] Open
Abstract
Cardiogenic shock is a primary cardiac disorder that results in both clinical and biochemical evidence of tissue hypoperfusion and can lead to multi-organ failure and death depending on its severity. Inadequate cardiac contractility or cardiac power secondary to acute myocardial infarction remains the most frequent cause of cardiogenic shock, although its contribution has declined over the past two decades, compared with other causes. Despite some advances in cardiogenic shock management, this clinical syndrome is still burdened by an extremely high mortality. Its management is based on immediate stabilization of haemodynamic parameters so that further treatment, including mechanical circulatory support and transfer to specialized tertiary care centres, can be accomplished. With these aims, medical therapy, consisting mainly of inotropic drugs and vasopressors, still has a major role. The purpose of this article is to review current evidence on the use of these medications in patients with cardiogenic shock and discuss specific clinical settings with indications to their use.
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Affiliation(s)
- Mauro Riccardi
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Matteo Pagnesi
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania
| | - Alexandre Mebazaa
- Université Paris Cité, Inserm MASCOT, AP-HP Department of Anesthesia and Critical Care, Hôpital Lariboisière, Paris, France
| | | | - Finn Gustafsson
- Heart Centre, Department of Cardiology, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark
| | - Daniela Tomasoni
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Nicola Latronico
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Department of Anesthesia, Intensive Care and Emergency, ASST Spedali Civili University Hospital, Brescia, Italy
| | - Marianna Adamo
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Metra
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Pascual Izco M, Ramírez-Carracedo R, Hernández Navarro I, Osorio Ruiz Á, Castejón Navarro B, Cuadrado Berrocal I, Largo Aramburu C, Alonso Salinas GL, Díez J, Saura Redondo M, Zamorano JL, Zaragoza C, Sanmartín M. Ivabradine in acute heart failure: Effects on heart rate and hemodynamic parameters in a randomized and controlled swine trial. Cardiol J 2018; 27:62-71. [PMID: 30155868 PMCID: PMC8086495 DOI: 10.5603/cj.a2018.0078] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 08/14/2018] [Accepted: 05/20/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Acute heart failure patients could benefit from heart rate reduction, as myocardial consumption and oxidative stress are related to tachycardia. Ivabradine could have a clinical role attenuating catecholamine-induced tachycardia. The aim of this study was to evaluate hemodynamic effects of ivabradine in a swine model of acute heart failure. METHODS Myocardial infarction was induced by 45 min left anterior descending artery balloon occlusion in 18 anesthetized pigs. An infusion of dobutamine and noradrenaline was maintained aiming to preserve adequate hemodynamic support, accompanied by fluid administration to obtain a pulmonary wedged pressure ≥ 18 mmHg. After reperfusion, rhythm and hemodynamic stabilization, the animals were randomized to 0.3 mg/kg ivabradine intravenously (n = 9) or placebo (n = 9). Hemodynamic parameters were observed over a 60 min period. RESULTS Ivabradine was associated with a significant reduction in heart rate (88.4 ± 12.0 bpm vs. 122.7 ± 17.3 bpm after 15 min of ivabradine/placebo infusion, p < 0.01) and an increase in stroke volume (68.8 ± 13.7 mL vs. 52.4 ± 11.5 mL after 15 min, p = 0.01). There were no significant differences in systemic or pulmonary arterial pressure, or significant changes in pulmonary capillary pressure. However, after 15 min, cardiac output was significantly reduced with ivabradine (-5.2% vs. +15.0% variation in ivabradine/placebo group, p = 0.03), and central venous pressure increased (+4.2% vs. -19.7% variation, p < 0.01). CONCLUSIONS Ivabradine reduces heart rate and increases stroke volume without modifying systemic or left filling pressures in a swine model of acute heart failure. However, an excessive heart rate reduction could lead to a decrease in cardiac output and an increase in right filling pressures. Future studies with specific heart rate targets are needed.
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Affiliation(s)
- Marina Pascual Izco
- Cardiology Department, Ramón y Cajal University Hospital (IRYCIS), University of Alcalá de Henares, Madrid, Spain
| | - Rafael Ramírez-Carracedo
- Cardiology Department, Cardiovascular Research Unit. Francisco de Vitoria University - Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | - Ignacio Hernández Navarro
- Cardiology Department, Cardiovascular Research Unit. Francisco de Vitoria University - Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | - Álvaro Osorio Ruiz
- Vascular Surgery Department, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | | | | | | | - Gonzalo Luis Alonso Salinas
- Cardiology Department, Ramón y Cajal University Hospital (IRYCIS), University of Alcalá de Henares, Madrid, Spain
- CIBERCV, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | - Javier Díez
- Cardiology Department, Cardiovascular Research Unit. Francisco de Vitoria University - Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | - Marta Saura Redondo
- Physiology Unit, Systems Biology Department, University of Alcalá de Henares, Madrid, Spain
| | - José Luis Zamorano
- Cardiology Department, Ramón y Cajal University Hospital (IRYCIS), University of Alcalá de Henares, Madrid, Spain
- CIBERCV, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | - Carlos Zaragoza
- Cardiology Department, Cardiovascular Research Unit. Francisco de Vitoria University - Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
- CIBERCV, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | - Marcelo Sanmartín
- Cardiology Department, Ramón y Cajal University Hospital (IRYCIS), University of Alcalá de Henares, Madrid, Spain.
- CIBERCV, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain.
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Oliva F, Sormani P, Contri R, Campana C, Carubelli V, Cirò A, Morandi F, Di Tano G, Mortara A, Senni M, Metra M, Ammirati E. Heart rate as a prognostic marker and therapeutic target in acute and chronic heart failure. Int J Cardiol 2018; 253:97-104. [DOI: 10.1016/j.ijcard.2017.09.191] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 06/12/2017] [Accepted: 09/22/2017] [Indexed: 12/28/2022]
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Poveda CM, Barrios-T. N, Rivera-P. M, Zuluaga-R. JF, Mendoza F. Ivabradina en el manejo de la falla cardiaca aguda por miocarditis. REVISTA COLOMBIANA DE CARDIOLOGÍA 2017. [DOI: 10.1016/j.rccar.2016.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Champion S. Comment on: Ivabradine: A Review of Labeled and Off-Label Uses. Am J Cardiovasc Drugs 2016; 16:473-474. [PMID: 27743223 DOI: 10.1007/s40256-016-0198-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sébastien Champion
- Réanimation, Clinique de Parly 2, Ramsay Générale de Santé, 21 rue Moxouris, 78150, Le Chesnay, France.
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Müller-Werdan U, Stöckl G, Werdan K. Advances in the management of heart failure: the role of ivabradine. Vasc Health Risk Manag 2016; 12:453-470. [PMID: 27895488 PMCID: PMC5118024 DOI: 10.2147/vhrm.s90383] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
A high resting heart rate (≥70–75 b.p.m.) is a risk factor for patients with heart failure (HF) with reduced ejection fraction (EF), probably in the sense of accelerated atherosclerosis, with an increased morbidity and mortality. Beta-blockers not only reduce heart rate but also have negative inotropic and blood pressure-lowering effects, and therefore, in many patients, they cannot be given in the recommended dose. Ivabradine specifically inhibits the pacemaker current (funny current, If) of the sinoatrial node cells, resulting in therapeutic heart rate lowering without any negative inotropic and blood pressure-lowering effect. According to the European Society of Cardiology guidelines, ivabradine should be considered to reduce the risk of HF hospitalization and cardiovascular death in symptomatic patients with a reduced left ventricular EF ≤35% and sinus rhythm ≥70 b.p.m. despite treatment with an evidence-based dose of beta-blocker or a dose below the recommended dose (recommendation class “IIa” = weight of evidence/opinion is in favor of usefulness/efficacy: “should be considered”; level of evidence “B” = data derived from a single randomized clinical trial or large nonrandomized studies). Using a heart rate cutoff of ≥ 75 b.p.m., as licensed by the European Medicines Agency, treatment with ivabradine 5–7.5 mg b.i.d. reduces cardiovascular mortality by 17%, HF mortality by 39% and HF hospitalization rate by 30%. A high resting heart rate is not only a risk factor in HF with reduced EF but also at least a risk marker in HF with preserved EF, in acute HF and also in special forms of HF. In this review, we discuss the proven role of ivabradine in the validated indication “HF with reduced EF” together with interesting preliminary findings, and the potential role of ivabradine in further, specific forms of HF.
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Affiliation(s)
| | - Georg Stöckl
- Department of Medical Affairs, Servier Deutschland GmbH, Munich
| | - Karl Werdan
- Department of Medicine III, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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Pascual Izco M, Alonso Salinas GL, Sanmartín Fernández M, Del Castillo Carnevalli H, Jiménez Mena M, Camino López A, Zamorano Gómez JL. Clinical Experience with Ivabradine in Acute Heart Failure. Cardiology 2016; 134:372-4. [DOI: 10.1159/000444845] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 02/18/2016] [Indexed: 11/19/2022]
Abstract
Objective: Ivabradine has been shown to improve symptoms and to reduce rehospitalization and mortality in patients with severe chronic heart failure (HF). Its indication in acute HF is not clear. Acute HF patients could also benefit from HR reduction, as myocardial consumption and oxidative stress are related to tachycardia. Moreover, beta-blockers are contraindicated in cardiogenic shock and should not be initiated with congestive signs. Accordingly, we evaluated the role of ivabradine in acute HF patients. Methods: This was a retrospective analysis of 29 consecutive patients treated for acute HF in the Cardiac ICU, and for whom ivabradine was initiated during hospitalization between January 2011 and January 2014. All patients were in sinus rhythm and had a heart rate (HR) >70 bpm. Catecholamine use was necessary in 16 patients (57.1%) during the hospitalization, in 14 (87.5%) of these before ivabradine treatment. Results: Systolic blood pressure showed no variation during the first 24 h of ivabradine administration or at discharge. HR showed an absolute reduction of 10 bpm at 6 h (p < 0.001), 11 bpm at 24 h (p = 0.004) and 19 bpm (p < 0.001) at discharge. No episodes of significant bradycardia or hypotension were recorded after starting the drug. Conclusions: HR reduction with ivabradine in acute HF is well tolerated. It represents an attractive option, especially when there is excessive catecholamine-related tachycardia; this should be appropriately evaluated in randomized trials.
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Abstract
Elevated resting heart rate has been linked to poor outcomes in patients with chronic systolic heart failure. Blockade of funny current channel with ivabradine reduces heart rate without inotropic effects. Ivabradine was recently approved by US Food and Drug Administration for patients with stable, symptomatic chronic heart failure (HF) with left ventricular ejection fraction (LVEF) ≤35 %, who are in sinus rhythm with resting heart rate (HR) ≥ 70 bpm and either are on maximally tolerated doses of beta-blockers, or have a contraindication to beta-blockers. This article will review and evaluate the data supporting the use of ivabradine in patients with HF and explore its mechanisms and physiologic effects.
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Affiliation(s)
- Gabriela Orasanu
- Advanced Heart Failure and Transplantation Center, Harrington Heart & Vascular Institute, Department of Medicine, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Sadeer G Al-Kindi
- Advanced Heart Failure and Transplantation Center, Harrington Heart & Vascular Institute, Department of Medicine, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Guilherme H Oliveira
- Advanced Heart Failure and Transplantation Center, Harrington Heart & Vascular Institute, Department of Medicine, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
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Cada DJ, Bindler R, Baker DE. Ivadradine. Hosp Pharm 2015; 50:806-17. [PMID: 26912922 PMCID: PMC4750831 DOI: 10.1310/hpj5009-806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are sent in print and are also available on-line. Monographs can be customized to meet the needs of a facility. A drug class review is now published monthly with The Formulary Monograph Service. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service, call The Formulary at 800-322-4349. The October 2015 monograph topics are sacubitril/valsartan, daclatasvir, sonidegib, alirocumab, and sodium zirconium cyclosilicate. The Safety MUE is on sacubitril/valsartan.
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Affiliation(s)
| | - Ross Bindler
- Drug Information Resident, College of Pharmacy, Washington State University Spokane
| | - Danial E Baker
- Director, Drug Information Center, and Professor of Pharmacy Practice, College of Pharmacy, Washington State University Spokane. The authors indicate no relationships that could be perceived as a conflict of interest
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Mert KU, Mert GÖ, Altun İ, Biteker M. Ivabradine in cardiogenic shock: Fact or fiction? Heart Lung 2015; 44:178. [DOI: 10.1016/j.hrtlng.2014.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 11/10/2014] [Accepted: 11/11/2014] [Indexed: 10/24/2022]
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