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von Haehling S, Doehner W, Evertz R, Garfias-Veitl T, Derad C, Diek M, Karakas M, Birkemeyer R, Fillippatos G, Lainscak M, Butler J, Ponikowski P, Böhm M, Friede T, Anker SD. Ferric carboxymaltose and exercise capacity in heart failure with preserved ejection fraction and iron deficiency: the FAIR-HFpEF trial. Eur Heart J 2024; 45:3789-3800. [PMID: 39185895 DOI: 10.1093/eurheartj/ehae479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/10/2024] [Accepted: 07/15/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND AND AIMS Evidence is lacking that correcting iron deficiency (ID) has clinically important benefits for patients with heart failure with preserved ejection fraction (HFpEF). METHODS FAIR-HFpEF was a multicentre, randomized, double-blind trial designed to compare intravenous ferric carboxymaltose (FCM) with placebo (saline) in 200 patients with symptomatic HFpEF and ID (serum ferritin < 100 ng/mL or ferritin 100-299 ng/mL with transferrin saturation < 20%). The primary endpoint was change in 6-min walking test distance (6MWTD) from baseline to week 24. Secondary endpoints included changes in New York Heart Association class, patient global assessment, and health-related quality of life (QoL). RESULTS The trial was stopped because of slow recruitment after 39 patients had been included (median age 80 years, 62% women). The change in 6MWTD from baseline to week 24 was greater for those assigned to FCM compared to placebo [least square mean difference 49 m, 95% confidence interval (CI) 5-93; P = .029]. Changes in secondary endpoints were not significantly different between groups. The total number of adverse events (76 vs. 114) and serious adverse events (5 vs. 19; rate ratio 0.27, 95% CI 0.07-0.96; P = .043) was lower with FCM than placebo. CONCLUSIONS In patients with HFpEF and markers of ID, intravenous FCM improved 6MWTD and was associated with fewer serious adverse events. However, the trial lacked sufficient power to identify or refute effects on symptoms or QoL. The potential benefits of intravenous iron in HFpEF with ID should be investigated further in a larger cohort.
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Affiliation(s)
- Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Center Goettingen, Georg- August University, Robert-Koch-Strasse 40, D-37075, Goettingen, Germany
- DZHK (German Center for Cardiovascular Research), Partner site Lower Saxony, Robert-Koch-Strasse 40, D-37075, Goettingen, Germany
| | - Wolfram Doehner
- Berlin Institute of Health-Center for Regenerative Therapies (BCRT), Charité- Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353, Berlin, Germany
- Deutsches Herzzentrum der Charité, Department of Cardiology (Campus Virchow), German Centre for Cardiovascular Research (DZHK) Partner site Berlin, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Goettingen, Georg- August University, Robert-Koch-Strasse 40, D-37075, Goettingen, Germany
- DZHK (German Center for Cardiovascular Research), Partner site Lower Saxony, Robert-Koch-Strasse 40, D-37075, Goettingen, Germany
| | - Tania Garfias-Veitl
- Department of Cardiology and Pneumology, University Medical Center Goettingen, Georg- August University, Robert-Koch-Strasse 40, D-37075, Goettingen, Germany
- DZHK (German Center for Cardiovascular Research), Partner site Lower Saxony, Robert-Koch-Strasse 40, D-37075, Goettingen, Germany
| | - Carlotta Derad
- DZHK (German Center for Cardiovascular Research), Partner site Lower Saxony, Robert-Koch-Strasse 40, D-37075, Goettingen, Germany
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Monika Diek
- Deutsches Herzzentrum der Charité, Department of Cardiology (Campus Virchow), German Centre for Cardiovascular Research (DZHK) Partner site Berlin, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353, Berlin, Germany
| | - Mahir Karakas
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), Partner site HH/Kiel/HL, Hamburg, Germany
| | | | - Gerasimos Fillippatos
- Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota, 9000 Murska Sobota, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
- Baylor Scott and White Research Institute, Dallas, TX, United States of America
| | - Piotr Ponikowski
- Center for Heart Diseases, University Hospital, Wroclaw Medical University, Wroclaw, Poland
| | - Michael Böhm
- Department of Internal Medicine Clinic III, Saarland University Hospital, Homburg/Saar, Germany
| | - Tim Friede
- DZHK (German Center for Cardiovascular Research), Partner site Lower Saxony, Robert-Koch-Strasse 40, D-37075, Goettingen, Germany
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Stefan D Anker
- Berlin Institute of Health-Center for Regenerative Therapies (BCRT), Charité- Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353, Berlin, Germany
- Deutsches Herzzentrum der Charité, Department of Cardiology (Campus Virchow), German Centre for Cardiovascular Research (DZHK) Partner site Berlin, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353, Berlin, Germany
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Hajiqasemi M, Ebrahimzade M, Ghelichkhan ZA, Huang X, Morkos D, Jennings D, Talasaz AH. Ivabradine Approved and Other Uses in Clinical Practice: A Systematic Review. J Cardiovasc Pharmacol 2024; 84:276-288. [PMID: 39027978 DOI: 10.1097/fjc.0000000000001609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 06/26/2024] [Indexed: 07/20/2024]
Abstract
ABSTRACT Heart rate (HR) stands as a prognostic indicator of cardiovascular disease and a modifiable risk factor in heart failure (HF). Medication intolerance can curtail the application of conventional HR-lowering β-blockers to the optimum target dose. Ivabradine (IVA), a specific negative-chronotropic agent, selectively inhibits I f current in pacemaker cells of the sinoatrial node without depressing myocardial contractility or comprising hemodynamics. This review summarized ivabradine's clinical labeled and off-label uses and mechanism of action focusing on the clinical outcomes. PubMed was searched up to January 2024 using the main keywords of IVA, coronary artery disease (CAD), HF, postural tachycardia syndrome (POTS), and tachyarrhythmia. To comprehensively review IVA's clinical indications, mechanisms, and therapeutic effects, all studies investigating treatment with IVA in humans were included, comprising different types of studies such as randomized controlled trials and longitudinal prospective observational studies. After screening, 141 studies were included in our review. A large number of reviewed articles were allocated to heart failure with reduced ejection fraction and CAD, suggesting IVA as an alternative to β-blockers in case of contraindications or intolerance. The beneficial effects of IVA as premedication for coronary computed tomography angiography, HR lowering in POTS, and inappropriate sinus tachycardia constituted most studies among off-label uses. The promising results have been reported on the efficacy of IVA in controlling HR, especially in patients with inappropriate sinus tachycardia or POTS. Owing to the unique mechanism of action, IVA has the potential to be used more frequently in future clinical practice.
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Affiliation(s)
| | | | | | - Xena Huang
- Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Department of Pharmacy Practice, Long Island University, New York, NY
- Department of Pharmacy, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY; and
| | - Demyana Morkos
- Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Department of Pharmacy Practice, Long Island University, New York, NY
| | - Douglas Jennings
- Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Department of Pharmacy Practice, Long Island University, New York, NY
- Department of Pharmacy, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY; and
| | - Azita H Talasaz
- Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Department of Pharmacy Practice, Long Island University, New York, NY
- Department of Pharmacy, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY; and
- Department of Pharmacotherapy and Outcome Sciences, Virginia Commonwealth University, Richmond, VA
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Waranugraha Y, Rizal A, Tjahjono CT, Vilado IY, David NI, Abudan F, Setyaningrum DA. A Systematic Review and Meta-Analysis of Randomised Controlled Trials Assessing Clinical and Haemodynamic Outcomes of Ivabradine in Heart Failure With Reduced Ejection Fraction Patients. Heart Lung Circ 2024; 33:962-974. [PMID: 38729854 DOI: 10.1016/j.hlc.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 08/25/2023] [Accepted: 09/02/2023] [Indexed: 05/12/2024]
Abstract
BACKGROUND Ivabradine, a pure bradycardic agent, can be given to heart failure reduced ejection fraction (HFrEF) patients with a sinus rhythm of ≥70 bpm on a maximum beta blocker dose, or when beta blockers are contraindicated. This study aimed to see how ivabradine affects the clinical and haemodynamic outcomes of HFrEF patients. METHODS This systematic review and meta-analysis searched ClinicalTrials.gov, OpenMD, ProQuest, PubMed, and ScienceDirect for potential articles. All relevant data were extracted. For all pooled effects, the random effect model was applied. RESULTS A total of 18,972 heart failure (HF) patients from nine randomised clinical trials (RCTs) were involved in this study. Ivabradine decreased the risk of HF mortality (RR 0.79; 95% CI 0.64-0.98; p=0.03) and HF hospitalisation (RR 0.80; 95% CI 0.65-0.97; p=0.03). Ivabradine was related to a greater reduction in heart rate (MD -12.21; 95% CI -15.47 - -8.96; p<0.01) and left ventricular ejection fraction (LVEF) improvement (MD 3.24; 95% CI 2.17-4.31; p <0.01) compared with placebo. Asymptomatic bradycardia (RR 4.25; 95% CI 3.36-5.39; p<0.01) and symptomatic bradycardia (RR 3.99; 95% CI 3.17-5.03; p<0.01) were higher in the ivabradine group. CONCLUSION Ivabradine can reduce the risk of HF mortality and HF hospitalisation in HFrEF patients. Ivabradine also effectively reduces resting heart rate and improves LVEF. However, ivabradine is associated with a greater risk of symptomatic and asymptomatic bradycardia.
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Affiliation(s)
- Yoga Waranugraha
- Department of Cardiology and Vascular Medicine, Brawijaya University Faculty of Medicine, Malang, Indonesia.
| | - Ardian Rizal
- Department of Cardiology and Vascular Medicine, Brawijaya University Faculty of Medicine, Malang, Indonesia
| | - Cholid Tri Tjahjono
- Department of Cardiology and Vascular Medicine, Brawijaya University Faculty of Medicine, Malang, Indonesia
| | - Irene Yasmina Vilado
- Undergraduate Program in Medicine, Faculty of Medicine, Brawijaya University Faculty of Medicine, Malang, Indonesia
| | - Nathanael Ibot David
- Undergraduate Program in Medicine, Faculty of Medicine, Brawijaya University Faculty of Medicine, Malang, Indonesia
| | - Fikri Abudan
- Undergraduate Program in Medicine, Faculty of Medicine, Brawijaya University Faculty of Medicine, Malang, Indonesia
| | - Dwi Ayu Setyaningrum
- Undergraduate Program in Medicine, Faculty of Medicine, Brawijaya University Faculty of Medicine, Malang, Indonesia
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Kawasaki S, Sakai Y, Harasawa S, Inatsu A, Kubota Y, Hirama A, Kashiwagi T, Iwabu M. The efficacy and safety of ivabradine hydrochloride in hemodialysis patients with chronic heart failure. Ther Apher Dial 2024; 28:354-363. [PMID: 38199237 DOI: 10.1111/1744-9987.14107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/20/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION There is little evidence for ivabradine hydrochloride in patients undergoing hemodialysis. METHODS In this open-label prospective interventional trial of hemodialysis patients with chronic heart failure, during 12 weeks of treatment, changes in Heart rate (HR), frequency of dialysis-related hypotension were examined, and we investigated health-related quality of life (HR-QOL) and adverse effects. RESULTS 18 patients from 6 facilities were enrolled in the study. HR significantly decreased over time, from 87 ± 12.61/min at baseline to 75.85 ± 8.91/min (p = 0.0003), and systolic blood pressure also increased significantly (p < 0.0001). The frequency of dialysis-related hypotension was markedly reduced (p = 0.0001). The HR-QOL survey showed significant improvements in Social Functioning among others (p = 0.0178). No specific adverse events occurred. CONCLUSION Ivabradine hydrochloride improved dialysis-related hypotension. Furthermore, the HR-QOL improvement effect were suggested. These results demonstrated the safety and effectiveness of ivabradine hydrochloride.
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Affiliation(s)
- Sayuri Kawasaki
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
- Akihabara Kidney Clinic, Tokyo, Japan
- Ayase-ekimae Kidney Clinic, Tokyo, Japan
| | - Yukinao Sakai
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | | | | | - Yoshiaki Kubota
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Akio Hirama
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
- Kidney Clinic of Nippon Medical School, Tokyo, Japan
| | - Tetsuya Kashiwagi
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Masato Iwabu
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
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Khan ZM, Briere JB, Olewinska E, Khrouf F, Nikodem M. Ivabradine in patients with heart failure: a systematic literature review. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2023; 11:2262073. [PMID: 37808119 PMCID: PMC10552613 DOI: 10.1080/20016689.2023.2262073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/15/2023] [Indexed: 10/10/2023]
Abstract
Background: Heart failure is a chronic disease linked with significant morbidity and mortality, and uncontrolled resting heart rate is a risk factor for adverse outcomes. This systematic literature review aimed to assess the efficacy, safety, and patient-reported outcomes (PROs) of ivabradine in patients with heart failure (HF) with reduced ejection fraction (HFrEF) in randomized controlled trials (RCTs) and observational studies. Methods: We searched electronic databases from their inception to July 2021 to include studies that reported on efficacy, safety, or PROs of ivabradine in patients with HFrEF. Results: Of 1947 records screened, 51 RCTs and 6 observational studies were identified. Ivabradine on top of background therapy demonstrated a significant reduction in composite outcomes including hospitalization for HF or cardiovascular death. In addition, observational studies suggested that ivabradine was associated with a significant reduction in mortality. Across all studies, ivabradine use on top of background therapy was associated with greater reductions in heart rate, improved EF, and improved health-related quality of life (QoL) and comparable risk of total adverse events compared to those treated with background therapy alone. Conclusions: Ivabradine on top of background therapy is beneficial for heart rate, hospitalization risk for HF, mortality, EF, and patients' QoL. Moreover, these benefits were achieved with no significant increase in the overall risk of total adverse events.
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Affiliation(s)
| | | | | | - Fatma Khrouf
- Health Economics and Outcome Research, Putnam PHMR, Tunis, Tunisia
| | - Mateusz Nikodem
- Health Economics and Outcome Research, Putnam PHMR, Cracow, Poland
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Corbo MD, Terlizzi VD, Barone R, Pellegrino P, Goffredo G, Pugliese R, Correale M, Ieva R, Di Biase M, Brunetti ND, Iacoviello M. Atrial paced rhythm and heart rate-dependent worsening of left atrial and ventricular function. Pacing Clin Electrophysiol 2023; 46:1116-1123. [PMID: 37573144 DOI: 10.1111/pace.14800] [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: 04/23/2023] [Revised: 07/05/2023] [Accepted: 08/01/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY The response to the increase in heart rate (HR) could be characterized by failure in both left ventricular (LV) and left atrial (LA) functions. This study aimed to evaluate the relationship between the increase in paced HR and the changes in LV and LA functions, assessed by two-dimensional speckle tracking analysis. METHODS In a group of patients with an implantable cardioverter defibrillator (ICD) or pacemaker, the atrial paced rhythm was progressively increased from 60 to 70, from 70 to 80, and from 80 to 90 beats per minute (bpm). For each paced HR, using two-dimensional speckle tracking analysis, LA reservoir (LAr), LA conduit (LAc), LA contraction (LAct), and LV global longitudinal strain (LV-GLS) were evaluated every 10 bpm. RESULTS Of the 45 patients enrolled, a significant reduction in LAr was observed at higher HR. However, when the patients were dichotomized according to the HR-related response of LV-GLS, the worsening of LAr was observed in those with LV-GLS worsening and not in those without (maximum LAR absolute changes -2.7 ± 7.2% vs. +2.7 ± 7.2%, respectively, p .028). Moreover, the worsening of LA and LV strain measures was associated with an increase in the estimated filling pressures. CONCLUSIONS In patients with atrial paced rhythm, the increase in HR could be associated with worsening of LA and LV functions, as assessed by two-dimensional speckle tracking analyses. These results offer new data on HR-related atrioventricular function and could be useful for guiding the optimal HR responsiveness of the implanted devices.
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Affiliation(s)
- Maria Delia Corbo
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Vito di Terlizzi
- Cardiology Unit, University Polyclinic Hospital of Foggia, Foggia, Italy
| | - Roberta Barone
- Cardiology Unit, University Polyclinic Hospital of Foggia, Foggia, Italy
| | | | - Giovanni Goffredo
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Rosanna Pugliese
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Michele Correale
- Cardiology Unit, University Polyclinic Hospital of Foggia, Foggia, Italy
| | - Riccardo Ieva
- Cardiology Unit, University Polyclinic Hospital of Foggia, Foggia, Italy
| | - Matteo Di Biase
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Natale Daniele Brunetti
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- Cardiology Unit, University Polyclinic Hospital of Foggia, Foggia, Italy
| | - Massimo Iacoviello
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
- Cardiology Unit, University Polyclinic Hospital of Foggia, Foggia, Italy
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Bak M, Choi JO. Optimization of guideline-directed medical treatment for heart failure patients with reduced ejection fraction. Korean J Intern Med 2023; 38:595-606. [PMID: 37680097 PMCID: PMC10493440 DOI: 10.3904/kjim.2023.223] [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: 05/18/2023] [Revised: 07/18/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023] Open
Abstract
With the increasing number of medications demonstrating mortality benefits in heart failure with reduced ejection fraction (HFrEF), the pharmacological treatment of HFrEF is entering a new phase. To enhance outcomes in heart failure patients through medical treatment, the choice of appropriate medications and simultaneous and rapid uptitration are critical. However, there are several challenges encountered during this medication uptitration, including issues like hypotension, fatigue, worsening renal function, and hyperkalemia. This paper addresses strategies for effectively managing these challenges to successfully reach the maximum tolerated dose in patients. Additionally, it will discuss the management of comorbidities often associated with heart failure, the importance of exercise and rehabilitation, and the significance of proper nutrition intake, in addition to guideline-directed medical therapy.
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Affiliation(s)
- Minjung Bak
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Shiga T, Suzuki T, Kida K, Suzuki A, Kohno T, Ushijima A, Kiuchi S, Ishii S, Murata M, Ijichi T, Suzuki M, Nishikawa M. Rationale and Design of the Effect of Ivabradine on Exercise Tolerance in Patients With Chronic Heart Failure (EXCILE-HF) Trial ― Protocol for a Multicenter Randomized Controlled Trial ―. Circ Rep 2023; 5:157-161. [PMID: 37025937 PMCID: PMC10072898 DOI: 10.1253/circrep.cr-22-0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/20/2023] [Accepted: 02/24/2023] [Indexed: 03/29/2023] Open
Abstract
Background: A high resting heart rate is an independent risk factor for mortality and morbidity in patients with cardiovascular diseases. Ivabradine selectively inhibits the funny current (I f) and decreases heart rate without affecting cardiac conduction, contractility, or blood pressure. The effect of ivabradine on exercise tolerance in patients with heart failure with reduced ejection fraction (HFrEF) on standard drug therapies remains unclear. Methods and Results: This multicenter interventional trial of patients with HFrEF and a resting heart rate ≥75 beats/min in sinus rhythm treated with standard drug therapies will consist of 2 periods: a 12-week open-label, randomized, parallel-group intervention period (standard drug treatment+ivabradine group and standard drug treatment group) to compare changes in exercise tolerance between the 2 groups; and a 12-week open-label ivabradine treatment period for all patients to evaluate the effect of adding ivabradine on exercise tolerance. The primary endpoint will be the change in peak oxygen uptake (V̇O2) during the cardiopulmonary exercise test from Week 0 (baseline) to Week 12. Secondary endpoints will be time-dependent changes in peak V̇O2 from Week 0 to Weeks 12 and 24. Adverse events will also be evaluated. Conclusions: The EXCILE-HF trial will provide meaningful information regarding the effects of ivabradine on exercise tolerance in patients with HFrEF receiving standard drug therapies and suggestions for the initiation of ivabradine treatment.
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Affiliation(s)
- Tsuyoshi Shiga
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine Tokyo Japan
- Department of Cardiology, Tokyo Women's Medical University Tokyo Japan
| | - Tsuyoshi Suzuki
- Department of Cardiology, Tokyo Women's Medical University Tokyo Japan
| | - Keisuke Kida
- Department of Pharmacology, St. Marianna University School of Medicine Kawasaki Japan
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University Tokyo Japan
| | - Takashi Kohno
- Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine Mitaka Japan
| | - Akiko Ushijima
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital Hachioji Japan
| | - Shunsuke Kiuchi
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine Tokyo Japan
| | - Shunsuke Ishii
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Makoto Murata
- Department of Cardiology, Gunma Prefectural Cardiovascular Center Maebashi Japan
| | - Takeshi Ijichi
- Department of Cardiology, Tokai University School of Medicine Isehara Japan
| | - Makoto Suzuki
- Department of Cardiology, Yokohama Minami Kyosai Hospital Yokohama Japan
| | - Masako Nishikawa
- Clinical Research Support Center, The Jikei University School of Medicine Tokyo Japan
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Rashad EA, Elsayed SS, Nasr JJM, Ibrahim FA. New ecological first derivative synchronous spectrofluorimetric method for simultaneous quantification of carvedilol and ivabradine in tablets. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2023; 289:122074. [PMID: 36508901 DOI: 10.1016/j.saa.2022.122074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 06/17/2023]
Abstract
A new, rapid, selective, green, and highly sensitive method has been established to determine ivabradine and carvedilol simultaneously. The first derivative synchronous spectrofluorimetric approach was applied for the determination of the studied drugs. Assessment of the first derivative amplitude of carvedilol and ivabradine has been done at 339 nm and 298 nm respectively which are the zero crossing points of each other. The method validation is estimated and was found to be consistent with International Conference on Harmonization guidelines. Linearity was found to be in the range of 10.0 to 90.0 ng/mL for carvedilol and from 80.0 to140.0 ng/mL for ivabradine. The detection limits were found to be 1.2 ng/ mL and 3.3 ng/mL and the quantitation limits were 3.7 ng / mL and 10.0 ng /mL for carvedilol and ivabradine, respectively. The method was effectively applied for the determination of both drugs in their synthetic mixture in different ratios and in their prepared co-formulated tablets. The results were compared with those of comparison HPLC methods. Ethanol was used as a green solvent. The proposed method is suitable for the determination of ivabradine and carvedilol with satisfactory accuracy and precision. The greenness of the method was evaluated using four assessment tools, i.e. NEMI, GAPI, Eco-scale, and AGREE. The proposed method is simple with a low cost compared to HPLC methods.
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Affiliation(s)
- Ethar A Rashad
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt.
| | - Samar S Elsayed
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt
| | - Jenny Jeehan M Nasr
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt
| | - Fawzia A Ibrahim
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt
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Koev I, Yarkoni M, Luria D, Amir O, Biton Y. Sudden cardiac death prevention in the era of novel heart failure medications. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 27:100281. [PMID: 38511092 PMCID: PMC10945958 DOI: 10.1016/j.ahjo.2023.100281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/18/2023] [Accepted: 02/19/2023] [Indexed: 03/22/2024]
Abstract
Sudden cardiac death (SCD) occurs unexpectedly and is usually a result of ventricular arrhythmia in patients with structural heart disease. The implantable cardioverter-defibrillator (ICD), with or without biventricular pacing, has been proven to be protective for heart failure patients with reduced ejection fraction of <35 % (HFrEF). This device therapy prevents SCD, with additional optimal medications, namely angiotensin-converting enzyme-inhibitors, angiotensin-II receptor-blockers, beta-blockers and mineralocorticoid receptor-antagonists. HFrEF patients present the majority of SCD incidents, as they are characterized by cardiac fibrosis, the main arrhythmogenic element. The introduction of angiotensin-receptor-neprilysin inhibitors, sodium-glucose co-transporter-2 inhibitors and guanylate-cyclase stimulators was associated with reduction of SCD. Additionally, clinical trials have evaluated the improved outcome of these new medications on left ventricular ejection fraction, arrhythmias and HFrEF. These beneficial effects could possibly lead to important changes in decision-making on ICD implantation for primary prevention in patients with HFrEF and reduce the need for device therapy. In this review, we highlight the pathophysiological mechanisms of the new drug agents, and evaluate the possible effect they could have on the role of device therapy as a primary prevention of SCD.
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Affiliation(s)
- I. Koev
- Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - M. Yarkoni
- Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - D. Luria
- Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - O. Amir
- Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Y. Biton
- Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel
- Heart Research Follow-Up Program, University of Rochester Medical Center, Rochester, NY, USA
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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11
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Mortara A, Rossi J, Mazzetti S, Catagnano F, Cavalotti C, Malerba G, Vecchio C, Morandi F, Nassiacos D, Oliva F. Hemodynamic effects of heart rate lowering in patients admitted for acute heart failure: the RedRate-HF Study (Reduction of heart Rate in Heart Failure). J Cardiovasc Med (Hagerstown) 2023; 24:113-122. [PMID: 36583979 DOI: 10.2459/jcm.0000000000001427] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND In patients admitted for acute heart failure (HF) indication for drugs which reduce the heart rate (HR) is debated. The multicentre prospective study Reduction of heart Rate in Heart Failure (RedRate-HF) was designed to analyse the hemodynamic effects of an early reduction of HR in acute HF. METHODS Hemodynamic parameters were recorded by using the bioimpedance technique, which was shown to be accurate, highly reproducible and sensitive to intra-observer changes. Lowering HR was obtained by ivabradine 5 mg bd, given 48-72 h after admission on the top of optimized treatment. Patients were followed at 24, 48, 72 h after drug assumption and at hospital discharge. RESULTS Twenty patients of a mean age of 67 ± 15 years, BNP at entry 1348 ± 1198 pg/ml were enrolled. Despite a clinical stabilization, after 48-72 h from admission, HR was persistently >70 bpm. Ivabradine was well tolerated in all patients with a significant increase in RR interval from 747 ± 69 ms at baseline to 948 ± 121 ms at discharge, P < 0.0001. Change in HR was associated with a significant increase in stroke volume (baseline 73 ± 22 vs. 84 ± 19 ml at discharge, P = 0.03), and reduction in left cardiac work index (baseline 3.6 ± 1.2 vs. 3.1 ± 1.1 kg/m2 at discharge, P = 0.04). Other measures of heart work were also significantly affected while cardiac output remained unchanged. CONCLUSION The strategy of an early lowering of HR in patients admitted for acute HF on top of usual care is feasible and safe. The HR reduction causes a positive increase in stroke volume and may contribute to saving energy without affecting cardiac output.
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Affiliation(s)
- Andrea Mortara
- Department of Clinical Cardiology, Policlinico di Monza, Monza
| | - Jessica Rossi
- Department of Clinical Cardiology, Policlinico di Monza, Monza
| | - Simone Mazzetti
- Department of Clinical Cardiology, Policlinico di Monza, Monza
| | - Francesco Catagnano
- Department of Clinical Cardiology, Policlinico di Monza, Monza.,Cardiology Department, University of Pavia, Pavia
| | | | - Gianluigi Malerba
- Department of Cardiovascular Science, University of Insubria, Circolo Hospital and Macchi Foundation, Varese
| | - Chiara Vecchio
- Department of Cardiology, Presidio Ospedaliero di Saronno, Saronno, Italy
| | - Fabrizio Morandi
- Department of Cardiovascular Science, University of Insubria, Circolo Hospital and Macchi Foundation, Varese
| | - Daniele Nassiacos
- Department of Cardiology, Presidio Ospedaliero di Saronno, Saronno, Italy
| | - Fabrizio Oliva
- Department of Cardiology, Niguarda Ca' Granda Hospital Milan
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12
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Mohan JC, Sathyamurthy I, Panja M, Agarwala R, Ponde CK, Kumar AS, Mahala BK, Kolapkar V, Kumar RVL, Patel K. Expert Consensus on Ivabradine-based Therapy for Heart Rate Management in Chronic Coronary Syndrome and Heart Failure with Reduced Ejection Fraction in India. Curr Cardiol Rev 2023; 19:97-106. [PMID: 36941812 PMCID: PMC10518888 DOI: 10.2174/1573403x19666230320105623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 03/23/2023] Open
Abstract
Heart rate is an important indicator of health and disease and the modulation of heart rate can help to improve cardiovascular outcomes. Besides β-blockers, Ivabradine is a wellestablished heart rate modulating drug that reduces heart rate without any hemodynamic effects. This consensus document was developed with the help of expert opinions from cardiologists across India on effective heart rate management in routine clinical practice and choosing an appropriate Ivabradine-based therapy considering the available scientific data and guideline recommendations. Based on the discussion during the meetings, increased heart rate was recognized as a significant predictor of adverse cardiovascular outcomes among patients with chronic coronary syndromes and heart failure with reduced ejection fraction making heart rate modulation important in these subsets. Ivabradine is indicated in the management of chronic coronary syndromes and heart failure with reduced ejection fraction for patients in whom heart rate targets cannot be achieved despite guideline-directed β-blocker dosing or having contraindication/intolerance to β-blockers. A prolonged release once-daily dosage of Ivabradine can be considered in patients already stabilized on Ivabradine twice-daily. Ivabradine/β-blocker fixed-dose combination can also be considered to reduce pill burden. Two consensus algorithms have been developed for further guidance on the appropriate usage of Ivabradine-based therapies. Ivabradine and β-blockers can provide more pronounced clinical improvement in most chronic coronary syndromes and heart failure with reduced ejection fraction patients with a fixed-dose combination providing an opportunity to improve adherence.
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Affiliation(s)
- J C Mohan
- Head of Department & Senior Consultant Cardiology, Jaipur Golden Hospital, Delhi, India
| | - I Sathyamurthy
- Senior Interventional Cardiologist, Apollo Hospitals, Chennai, India
| | - Monotosh Panja
- Senior Interventional Cardiologist, AMRI Hospitals, Kolkata, India
| | - Rajeev Agarwala
- Head of Department and Consultant Cardiologist, Jaswant Rai Speciality Hospital, Meerut, India
| | - C K Ponde
- Head of Department and Consultant Cardiologist, P. D. Hinduja National Hospital & Medical Research Centre, Mumbai, India
| | - A Sreenivas Kumar
- Director Cardiology & Clinical Research, Apollo Health City, Hyderabad, India; Apollo Hospitals, Hyderabad, India
| | - Bijay Kumar Mahala
- Senior Consultant Cardiology, Narayana Institute of Cardiac Sciences, Bangalore, India
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13
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von Haehling S. Erhalt der Selbstständigkeit bei Herzinsuffizienz: Ansatzpunkte und Konsequenzen für den Alltag. AKTUELLE KARDIOLOGIE 2022. [DOI: 10.1055/a-1820-8230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
ZusammenfassungErhalt von Mobilität und sozialer Interaktion hat für Patienten mit Herzinsuffizienz enorme Alltagsbedeutung, die in vielen bisher durchgeführten Therapiestudien nicht in ausreichendem Maße
abgebildet wurde. Ivabradin, die SGLT2-Inhibitoren Empagliflozin und Dapagliflozin sowie der ARNI Sacubitril/Valsartan bieten hier erste Möglichkeiten der Einflussnahme. Auch
Ausdauertraining ist sehr zu empfehlen. Die Therapie von Komorbiditäten bei Herzinsuffizienz zeigt vor allem bei der Therapie des Eisenmangels gute Möglichkeiten der Besserung der
Belastbarkeit, außerdem durch die Pulmonalvenenisolation bei Vorhofflimmern. Andere Aspekte, welche die Mobilität der Patienten verbessern, sind das Ermöglichen von selbstständigem Führen
von Fahrzeugen, von Sport und Hobbys, Berufstätigkeit und Sexualität sowie das Ermöglichen von Reiseaktivitäten, wenn die Patienten entsprechend vorbereitet sind, über ausreichend
Informationen für die Reiseaktivität verfügen und das Reiseziel entsprechend ausgewählt wurde. Wichtig ist, die Bedürfnisse des Patienten zu erfragen, um individualisierte Therapiekonzepte
zu erarbeiten.
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Affiliation(s)
- Stephan von Haehling
- Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
- Deutsches Zentrum für Herz- und Kreislaufforschung (DZHK), Standort Göttingen, Deutschland
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14
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Rosano GM, Vitale C, Adamo M, Metra M. Roadmap for the management of heart failure patients during the vulnerable phase after heart failure hospitalizations: how to implement excellence in clinical practice. J Cardiovasc Med (Hagerstown) 2022; 23:149-156. [PMID: 34937849 PMCID: PMC10484190 DOI: 10.2459/jcm.0000000000001221] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/08/2021] [Accepted: 05/27/2021] [Indexed: 11/05/2022]
Abstract
Patients discharged after an episode of acute heart failure have an increased risk of hospitalizations and deaths within the subsequent 3 months. This phase is commonly called the 'vulnerable period' and it represents a window of opportunity of intervention in order to improve longer term outcomes. Prompt identification of signs of residual haemodynamic congestion is a priority in planning for the out-of-hospital management strategies. Patients will also need to be screened for frailty and have a prioritization of the management of their comorbidities. Life-saving medications should be started together or in a short time and up-titrated (when needed) according to blood pressure, heart rate and concomitant comorbidities. Ideally, patients should be assessed by their general practitioner within 1 week of discharge and have a hospital/clinic follow-up within 4 weeks of discharge. Patients should progressively resume physical activities and adhere to an educational programme with appropriate lifestyle adjustments best implemented during a cardiac rehabilitation programme.
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Affiliation(s)
- Giuseppe M.C. Rosano
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, Rome
| | - Cristiana Vitale
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, Rome
| | - Marianna Adamo
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Bresica, Italy
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Bresica, Italy
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15
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Tóth N, Soós A, Váradi A, Hegyi P, Tinusz B, Vágvölgyi A, Orosz A, Solymár M, Polyák A, Varró A, Farkas AS, Nagy N. Effect of ivabradine in heart failure: a meta-analysis of heart failure patients with reduced versus preserved ejection fraction. Can J Physiol Pharmacol 2021; 99:1159-1174. [PMID: 34636643 DOI: 10.1139/cjpp-2020-0700] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In clinical trials of heart failure reduced ejection fraction (HFrEF), ivabradine seemed to be an effective heart rate lowering agent associated with lower risk of cardiovascular death. In contrast, ivabradine failed to improve cardiovascular outcomes in heart failure preserved ejection fraction (HFpEF) despite the significant effect on heart rate. This meta-analysis is the first to compare the effects of ivabradine on heart rate and mortality parameters in HFpEF versus HFrEF. We screened three databases: PubMed, Embase, and Cochrane Library. The outcomes of these studies were mortality, reduction in heart rate, and left ventricular function improvement. We compared the efficacy of ivabradine treatment in HFpEF versus HFrEF. Heart rate analysis of pooled data showed decrease in both HFrEF (-17.646 beats/min) and HFpEF (-11.434 beats/min), and a tendency to have stronger bradycardic effect in HFrEF (p = 0.094) in randomized clinical trials. Left ventricular ejection fraction analysis revealed significant improvement in HFrEF (5.936, 95% CI: [4.199-7.672], p < 0.001) when compared with placebo (p < 0.001). We found that ivabradine significantly improves left ventricular performance in HFrEF, at the same time it exerts a tendency to have improved bradycardic effect in HFrEF. These disparate effects of ivabradine and the higher prevalence of non-cardiac comorbidities in HFpEF may explain the observed beneficial effects in HFrEF and the unchanged outcomes in HFpEF patients after ivabradine treatment.
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Affiliation(s)
- Noémi Tóth
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School University of Szeged, Dóm Square 12, Szeged 6720, Hungary
| | - Alexandra Soós
- Institute for Translational Medicine, Medical School, University of Pécs, 12 Szigeti Street, Pécs 7624, Hungary
| | - Alex Váradi
- Institute for Translational Medicine, Medical School, University of Pécs, 12 Szigeti Street, Pécs 7624, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, 12 Szigeti Street, Pécs 7624, Hungary
| | - Benedek Tinusz
- Institute for Translational Medicine, Medical School, University of Pécs, 12 Szigeti Street, Pécs 7624, Hungary.,First Department of Medicine, Medical School, University of Pécs, Ifjúság Street 13, Pécs 7624, Hungary
| | - Anna Vágvölgyi
- Department of Internal Medicine, Albert Szent-Györgyi Medical School University of Szeged, Kálvária sgt. 57, Szeged 6720, Hungary
| | - Andrea Orosz
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School University of Szeged, Dóm Square 12, Szeged 6720, Hungary
| | - Margit Solymár
- Institute for Translational Medicine, Medical School, University of Pécs, 12 Szigeti Street, Pécs 7624, Hungary
| | - Alexandra Polyák
- Department of Internal Medicine, Albert Szent-Györgyi Medical School University of Szeged, Kálvária sgt. 57, Szeged 6720, Hungary
| | - András Varró
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School University of Szeged, Dóm Square 12, Szeged 6720, Hungary.,ELKH-SZTE Research Group of Cardiovascular Pharmacology, Szeged, Hungary
| | - Attila S Farkas
- Department of Internal Medicine, Albert Szent-Györgyi Medical School University of Szeged, Kálvária sgt. 57, Szeged 6720, Hungary
| | - Norbert Nagy
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School University of Szeged, Dóm Square 12, Szeged 6720, Hungary.,ELKH-SZTE Research Group of Cardiovascular Pharmacology, Szeged, Hungary
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16
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Rosano GMC, Moura B, Metra M, Böhm M, Bauersachs J, Ben Gal T, Adamopoulos S, Abdelhamid M, Bistola V, Čelutkienė J, Chioncel O, Farmakis D, Ferrari R, Filippatos G, Hill L, Jankowska EA, Jaarsma T, Jhund P, Lainscak M, Lopatin Y, Lund LH, Milicic D, Mullens W, Pinto F, Ponikowski P, Savarese G, Thum T, Volterrani M, Anker SD, Seferovic PM, Coats AJS. Patient profiling in heart failure for tailoring medical therapy. A consensus document of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2021; 23:872-881. [PMID: 33932268 DOI: 10.1002/ejhf.2206] [Citation(s) in RCA: 150] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/17/2021] [Accepted: 04/29/2021] [Indexed: 12/22/2022] Open
Abstract
Despite guideline recommendations and available evidence, implementation of treatment in heart failure (HF) is poor. The majority of patients are not prescribed drugs at target doses that have been proven to positively impact morbidity and mortality. Among others, tolerability issues related to low blood pressure, heart rate, impaired renal function or hyperkalaemia are responsible. Chronic kidney disease plays an important role as it affects up to 50% of patients with HF. Also, dynamic changes in estimated glomerular filtration rate may occur during the course of HF, resulting in inappropriate dose reduction or even discontinuation of decongestive or neurohormonal modulating therapy in clinical practice. As patients with HF are rarely naïve to pharmacologic therapies, the challenge is to adequately prioritize or select the most appropriate up-titration schedule according to patient profile. In this consensus document, we identified nine patient profiles that may be relevant for treatment implementation in HF patients with a reduced ejection fraction. These profiles take into account heart rate (<60 bpm or >70 bpm), the presence of atrial fibrillation, symptomatic low blood pressure, estimated glomerular filtration rate (<30 or >30 mL/min/1.73 m2 ) or hyperkalaemia. The pre-discharge patient, frequently still congestive, is also addressed. A personalized approach, adjusting guideline-directed medical therapy to patient profile, may allow to achieve a better and more comprehensive therapy for each individual patient than the more traditional, forced titration of each drug class before initiating treatment with the next.
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Affiliation(s)
| | - Brenda Moura
- Armed Forces Hospital, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Marco Metra
- Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | | | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Tuvia Ben Gal
- Department of Cardiology, Rabin Medical Centre, Petah Tikva, Israel
| | | | - Magdy Abdelhamid
- Faculty of Medicine, Department of Cardiology, Cairo University, Giza, Egypt
| | - Vasiliki Bistola
- Department of Cardiology, Attikon University Hospital, University of Athens Medical School, Athens, Greece
| | - Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | - Ovidiu Chioncel
- University of Medicine Carol Davila, Bucharest, Romania.,Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania
| | | | - Roberto Ferrari
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.,Centro Cardiologico Universitario di Ferrara, University of Ferrara, Ferrara, Italy
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, University Hospital Attikon, Athens, Greece
| | - Loreena Hill
- School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland, UK
| | - Ewa A Jankowska
- Department of Heart Diseases, Wroclaw Medical University and Center for Heart Diseases, University Hospital in Wroclaw, Wroclaw, Poland
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linkoping University, Linköping, Sweden.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pardeep Jhund
- Institute of Cardiovascular and Medical Sciences, Glasgow, UK
| | - Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Yuri Lopatin
- Volgograd State Medical University, Regional Cardiology Centre Volgograd, Volgograd, Russian Federation
| | - Lars H Lund
- Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Davor Milicic
- University of Zagreb School of Medicine, Zagreb, Croatia
| | - Wilfried Mullens
- Faculty of Medicine and Life Sciences, BIOMED - Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium.,Department of Cardiology, Ziekenhuis Oost, Genk, Belgium
| | - Fausto Pinto
- Cardiology Department, University Hospital Santa Maria (CHULN), CAML, CCUL, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Piotr Ponikowski
- Centre for Heart Diseases, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Gianluigi Savarese
- Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Thomas Thum
- Hannover Medical School, Institute of Molecular and Translational Therapeutic Strategies, Hannover, Germany
| | | | - Stefan D Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Petar M Seferovic
- Department Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Serbian Academy of Sciences and Arts, Belgrade, Serbia
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17
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Bryan Richard S, Huang B, Liu G, Yang Y, Luo S. Impact of ivabradine on the cardiac function of chronic heart failure reduced ejection fraction: Meta-analysis of randomized controlled trials. Clin Cardiol 2021; 44:463-471. [PMID: 33638556 PMCID: PMC8027585 DOI: 10.1002/clc.23581] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 01/26/2023] Open
Abstract
Elevated resting heart rate in chronic heart failure (HF) patients has been associated with higher mortality and poor prognosis. Ivabradine is a new pure bradycardic agent that has been used to treat angina or heart failure reduced ejection fraction (HFrEF) with sinus heart rate above 70 beats per minute. However, the effect of ivabradine for chronic HF patients on rehospitalization and cardiac function is still inconsistent. Thus, this meta‐analysis aimed to elucidate the effect of Ivabradine in chronic HFrEF patients. We systematically searched PubMed, Medline, Clinical Trials.gov, and The Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs) of ivabradine with search terms Ivabradine (MeSH Terms), chronic heart failure and beta‐blocker. The primary endpoints of the study include the impact of Ivabradine on heart rate, left ventricle ejection fraction (LVEF), left ventricular remodeling, exercise capacity, and quality of life (QoL) in patients with chronic HFrEF. Secondary endpoints were safety analysis of Ivabradine including cardiovascular mortality, worsening HF readmission, visual disturbances, and asymptomatic bradycardia. The analysis was done by Review Manager 5.4 Analyzer, to analyze the mean differences (MD) for continuous data and risks ratio (RR) for dichotomous data. A total of six RCTs and one subgroup analysis showed add of Ivabradine to standard HF therapy was associated with greater resting heart rate reduction (MD = −9.57; 95% CI ‐11.15, −8.00), improved LVEF (MD = 3.89; 95% CI 2.61, 5.17), left ventricular reverse remodeling improvement (MD = −3.73; 95% CI ‐4.25, −3.21, LVESV; MD = −17.00, 95%CI ‐29.65, −4.35, LVEDD; MD = −1.43, 95%CI ‐2.78, −0.08, LVEDV; MD = −14.75, 95%CI ‐34.36, 4.87), increased exercise capacity (exercise duration; MD = 8.52; 95%CI 0.09, 16.94), and significant reduction on rehospitalization due to worsening HF (RR = 0.76, 95%CI 0.69, 0.84). However, Ivabradine has no significant effect on the quality of life (MD = 0.65; 95%CI ‐10.52, 11.82), and cardiovascular mortality (RR = 0.92; 95%CI 0.82, 1.03). Moreover, there were some events of visual disturbances and asymptomatic bradycardia observed in the Ivabradine group compared to the placebo group (RR = 4.76; 95%CI 3.03, 7.48; RR = 3.78; 95%CI 2.77, 5.15, respectively). Addition of Ivabradine to standard HF therapy is associated with cardiac function improvement, reduction on worsening HF readmission, greater HR reduction, and better exercise capacity in chronic HFrEF patients, although it cannot reduce cardiovascular mortality or improve the quality of life.
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Affiliation(s)
- Sasmita Bryan Richard
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bi Huang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Gang Liu
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuan Yang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Suxin Luo
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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18
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Wan H, Huang T, Zhang H, Wu Q. Effects of Ivabradine on Cardiac Remodeling in Patients With Stable Symptomatic Heart Failure: A Systematic Review and Meta-analysis. Clin Ther 2020; 42:2289-2297.e0. [PMID: 33160681 DOI: 10.1016/j.clinthera.2020.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/30/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Ivabradine reduces heart rate (HR) in patients with heart failure (HF). However, its effect on cardiac remodeling is not obvious. The goal of this study was to explore the extra effect of ivabradine on cardiac remodeling in patients with HF. METHODS We searched PubMed from database inception to January 31, 2020, Cochrane and Embase from database inception to February 2, 2020, and Web of Science and ClinicalTrials.gov from database inception to February 3, 2020, for randomized controlled trials on ivabradine treatments in patients with stable symptomatic HF, left ventricular ejection fraction (LVEF) < 45%, and resting HR ≥ 60 beats/min in sinus rhythm. We pooled the mean differences (MDs) or standardized mean differences and their 95% CIs. An inverse variance was used to combine data. Fixed- or random-effects models were used to outline the outcomes based on heterogeneity levels. We assessed the heterogeneity among studies according to the I2 statistic. A sensitivity analysis for select results was performed to assess the robustness of the outcomes. FINDINGS Of 2277 trials, 9 trials fulfilled the inclusion criteria. A total of 1523 patients were enrolled in 9 studies. There were 796 participants in the ivabradine group and 727 participants in the control group. The duration of follow-up ranged from 6 weeks to 19.6 months. The mean (SD) age of the participants was 59.7 (11.2) years, and 1187 participants (77.9%) were men. Therapy with ivabradine was related to reversing cardiac remodeling with a significant increase in LVEF (MD = 3.04%; 95% CI, 2.07%-4.00%; p < 0.001), decrease in the left ventricular end-systolic volume index (LVESVI) (MD = -7.30 mL/m2; 95% CI, -12.94 to -1.66 mL/m2; p = 0.01), and reduction in the left ventricular end-diastolic volume index (LVEDVI) (MD = -7.27 mL/m2; 95% CI, -14.04 to -0.50 mL/m2; p = 0.04). In the subgroup of enrolled patients with a resting HR of ≥70 beats/min, greater progress in LVEF was detected in the ivabradine group (MD = 3.60%; 95% CI, 2.40%-4.81%; p < 0.001), and a higher improvement in LVESVI was identified in the ivabradine group (MD = -11.06 mL/m2; 95% CI, -21.15 to -0.98 mL/m2; p = 0.03). IMPLICATIONS In patients with stable symptomatic HF, LVEF <45%, and resting HR ≥ 60 beats/min in sinus rhythm, ivabradine use was associated with reversing cardiac remodeling with a significant increase in LVEF, a decrease in LVESVI, and a reduction in LVEDVI.
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Affiliation(s)
- Hongbing Wan
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
| | - Tieqiu Huang
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Hongzhou Zhang
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Qinghua Wu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
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Benstoem C, Kalvelage C, Breuer T, Heussen N, Marx G, Stoppe C, Brandenburg V. Ivabradine as adjuvant treatment for chronic heart failure. Cochrane Database Syst Rev 2020; 11:CD013004. [PMID: 33147368 PMCID: PMC8094176 DOI: 10.1002/14651858.cd013004.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Chronic heart failure is one of the most common medical conditions, affecting more than 23 million people worldwide. Despite established guideline-based, multidrug pharmacotherapy, chronic heart failure is still the cause of frequent hospitalisation, and about 50% die within five years of diagnosis. OBJECTIVES To assess the effectiveness and safety of ivabradine in individuals with chronic heart failure. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, and CPCI-S Web of Science in March 2020. We also searched ClinicalTrials.gov and the WHO ICTRP. We checked reference lists of included studies. We did not apply any time or language restrictions. SELECTION CRITERIA We included randomised controlled trials in which adult participants diagnosed with chronic heart failure were randomly assigned to receive either ivabradine or placebo/usual care/no treatment. We distinguished between type of heart failure (heart failure with a reduced ejection fraction or heart failure with a preserved ejection fraction) as well as between duration of ivabradine treatment (short term (< 6 months) or long term (≥ 6 months)). DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion, extracted data, and checked data for accuracy. We calculated risk ratios (RR) using a random-effects model. We completed a comprehensive 'Risk of bias' assessment for all studies. We contacted authors for missing data. Our primary endpoints were: mortality from cardiovascular causes; quality of life; time to first hospitalisation for heart failure during follow-up; and number of days spent in hospital due to heart failure during follow-up. Our secondary endpoints were: rate of serious adverse events; exercise capacity; and economic costs (narrative report). We assessed the certainty of the evidence applying the GRADE methodology. MAIN RESULTS We included 19 studies (76 reports) involving a total of 19,628 participants (mean age 60.76 years, 69% male). However, few studies contributed data to meta-analyses due to inconsistency in trial design (type of heart failure) and outcome reporting and measurement. In general, risk of bias varied from low to high across the included studies, with insufficient detail provided to inform judgement in several cases. We were able to perform two meta-analyses focusing on participants with heart failure with a reduced ejection fraction (HFrEF) and long-term ivabradine treatment. There was evidence of no difference between ivabradine and placebo/usual care/no treatment for mortality from cardiovascular causes (RR 0.99, 95% confidence interval (CI) 0.88 to 1.11; 3 studies; 17,676 participants; I2 = 33%; moderate-certainty evidence). Furthermore, we found evidence of no difference in rate of serious adverse events amongst HFrEF participants randomised to receive long-term ivabradine compared with those randomised to placebo, usual care, or no treatment (RR 0.96, 95% CI 0.92 to 1.00; 2 studies; 17,399 participants; I2 = 12%; moderate-certainty evidence). We were not able to perform meta-analysis for all other outcomes, and have low confidence in the findings based on the individual studies. AUTHORS' CONCLUSIONS We found evidence of no difference in cardiovascular mortality and serious adverse events between long-term treatment with ivabradine and placebo/usual care/no treatment in participants with heart failure with HFrEF. Nevertheless, due to indirectness (male predominance), the certainty of the available evidence is rated as moderate.
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Affiliation(s)
- Carina Benstoem
- Department of Intensive Care Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Christina Kalvelage
- Department of Intensive Care Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Thomas Breuer
- Department of Intensive Care Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Nicole Heussen
- Department of Medical Statistics, Medical Faculty RWTH Aachen University, Aachen, Germany
- Center of Biostatistic and Epidemiology, Medical School, Sigmund Freud Private University, Vienna, Austria
| | - Gernot Marx
- Department of Intensive Care Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Christian Stoppe
- Department of Intensive Care Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Vincent Brandenburg
- Department of Cardiology, Medical Faculty, University Hospital RWTH Aachen, Aachen, Germany
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20
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Soylu K, Cerik IB, Aksan G, Nar G, Meric M. Evaluation of ivabradine in left ventricular dyssynchrony and reverse remodeling in patients with chronic heart failure. J Arrhythm 2020; 36:762-767. [PMID: 32782651 PMCID: PMC7411195 DOI: 10.1002/joa3.12398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/13/2020] [Accepted: 06/18/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Ivabradine is a pharmacological agent used in patients with heart failure and sinus rhythm. Its only known pharmacological effect is to slow the heart rate. In this study, we investigated the impact of ivabradine on dyssynchrony parameters in heart failure patients. METHODS In this study, we assigned 55 patients taking medication for heart failure to receive ivabradine in addition (Group I). Twenty healthy volunteers comprised Group II. Echocardiographic measurements (dyssynchrony, left ventricular volumes and left ventricular ejection fraction) were taken at baseline, 1 month, and 3 months. RESULTS A total of 32 heart failure patients in Group I completed the study. There was significant improvement in dyssynchrony parameters after ivabradine treatment in Group I. Interventricular dyssynchrony (IVD) decreased from 42.0 ± 24.4 milliseconds at baseline to 33.6 ± 20.7 milliseconds at 1 month (P = .001) and to 30.7 ± 19.4 milliseconds at 3 months (P < .001). Septal to posterior wall motion delay decreased from 90.3 ± 21.4 milliseconds to 83.9 ± 26.9 milliseconds (P = .011) at 1 month and to 81.5 ± 27.3 milliseconds at 3 months (P = .001). Septal to lateral Ts delay (Ts-SL) decreased from 42.7 ± 24.5 milliseconds to 35.8 ± 22.6 milliseconds at 1 month (P < .001) and to 34.8 ± 22.4 milliseconds at 3 months (P = .002). Left ventricular end-systolic volume (LVESV) decreased from 139.4 ± 42.2 mL to 135.3 ± 39.6 mL at 1 month (P = .006) and to 123.3 ± 39.5 mL at 3 months (P < .001). CONCLUSION The addition of ivabradine to heart failure treatment improves cardiac dyssynchrony parameters in chronic systolic heart failure patients with sinus rhythm.
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Affiliation(s)
- Korhan Soylu
- Department of CardiologyFaculty of MedicineOndokuz Mayis UniversitySamsunTurkey
| | - Idris Bugra Cerik
- Department of CardiologyFaculty of MedicineCumhuriyet UniversitySivasTurkey
| | - Gokhan Aksan
- Department of CardiologySamsun Education and Research HospitalSamsunTurkey
| | - Gokay Nar
- Department of CardiologyFaculty of MedicinePamukkale UniversityDenizliTurkey
| | - Murat Meric
- Department of CardiologyFaculty of MedicineOndokuz Mayis UniversitySamsunTurkey
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21
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Abstract
Ivabradine is a pure heart-rate lowering drug that is nowadays used, accordingly to the last ESC Guidelines, to reduce mortality and heart failure (HF) hospitalization in patients with HF with reduced ejection fraction and in symptomatic patiens with inappropriate sinus tachycardia. Moreover, interesting effect of ivabradine on endothelial and myocardial function and on oxidative stress and inflamation pathways are progressively emerging. The aim of this paper is to highlight newer evidences about ivabradine effect (and consequently possible future application of the drug) in pathological settings different from guidelines-based clinical practice.
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Affiliation(s)
- Lucia Dallapellegrina
- Cardio-Thoracic Department, ASST Spedali Civili, Piazzale Spedali Civili 1, Brescia, 25128, Italy.,Department of Medical and Surgical Specialties, Cardiology Unit, Radiological Sciences and Public Health, University of Brescia, Italy
| | - Edoardo Sciatti
- Department of Medical and Surgical Specialties, Cardiology Unit, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,Cardio-Thoracic Department, ASST Spedali Civili, Brescia, Italy
| | - Enrico Vizzardi
- Department of Medical and Surgical Specialties, Cardiology Unit, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,Cardio-Thoracic Department, ASST Spedali Civili, Brescia, Italy
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22
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von Haehling S, Arzt M, Doehner W, Edelmann F, Evertz R, Ebner N, Herrmann-Lingen C, Garfias Macedo T, Koziolek M, Noutsias M, Schulze PC, Wachter R, Hasenfuß G, Laufs U. Improving exercise capacity and quality of life using non-invasive heart failure treatments: evidence from clinical trials. Eur J Heart Fail 2020; 23:92-113. [PMID: 32392403 DOI: 10.1002/ejhf.1838] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 04/14/2020] [Indexed: 12/28/2022] Open
Abstract
Endpoints of large-scale trials in chronic heart failure have mostly been defined to evaluate treatments with regard to hospitalizations and mortality. However, patients with heart failure are also affected by very severe reductions in exercise capacity and quality of life. We aimed to evaluate the effects of heart failure treatments on these endpoints using available evidence from randomized trials. Interventions with evidence for improvements in exercise capacity include physical exercise, intravenous iron supplementation in patients with iron deficiency, and - with less certainty - testosterone in highly selected patients. Erythropoiesis-stimulating agents have been reported to improve exercise capacity in anaemic patients with heart failure. Sinus rhythm may have some advantage when compared with atrial fibrillation, particularly in patients undergoing pulmonary vein isolation. Studies assessing treatments for heart failure co-morbidities such as sleep-disordered breathing, diabetes mellitus, chronic kidney disease and depression have reported improvements of exercise capacity and quality of life; however, the available data are limited and not always consistent. The available evidence for positive effects of pharmacologic interventions using angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and mineralocorticoid receptor antagonists on exercise capacity and quality of life is limited. Studies with ivabradine and with sacubitril/valsartan suggest beneficial effects at improving quality of life; however, the evidence base is limited in particular for exercise capacity. The data for heart failure with preserved ejection fraction are even less positive, only sacubitril/valsartan and spironolactone have shown some effectiveness at improving quality of life. In conclusion, the evidence for state-of-the-art heart failure treatments with regard to exercise capacity and quality of life is limited and appears not robust enough to permit recommendations for heart failure. The treatment of co-morbidities may be important for these patient-related outcomes. Additional studies on functional capacity and quality of life in heart failure are required.
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Affiliation(s)
- Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Michael Arzt
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Wolfram Doehner
- BCRT - Berlin Institute of Health Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum and German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum and German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Nicole Ebner
- Department of Cardiology and Pneumology, University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Tania Garfias Macedo
- Department of Cardiology and Pneumology, University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Michael Koziolek
- Department of Nephrology and Rheumatology, University of Göttingen Medical Center, Göttingen, Germany
| | - Michel Noutsias
- Mid-German Heart Center, Division of Cardiology, Angiology and Intensive Medical Care, Department of Internal Medicine III, University Hospital Halle, Martin-Luther-University Halle, Halle (Saale), Germany
| | - P Christian Schulze
- Division of Cardiology, Pneumology, Angiology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - Rolf Wachter
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
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23
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Liang B, Zhao YX, Zhang XX, Liao HL, Gu N. Reappraisal on pharmacological and mechanical treatments of heart failure. Cardiovasc Diabetol 2020; 19:55. [PMID: 32375806 PMCID: PMC7202267 DOI: 10.1186/s12933-020-01024-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/25/2020] [Indexed: 02/07/2023] Open
Abstract
Heart failure (HF) is a highly frequent disorder with considerable morbidity, hospitalization, and mortality; thus, it invariably places pressure on clinical and public health systems in the modern world. There have been notable advances in the definition, diagnosis, and treatment of HF, and newly developed agents and devices have been widely adopted in clinical practice. Here, this review first summarizes the current emerging therapeutic agents, including pharmacotherapy, device-based therapy, and the treatment of some common comorbidities, to improve the prognosis of HF patients. Then, we discuss and point out the commonalities and areas for improvement in current clinical studies of HF. Finally, we highlight the gaps in HF research. We are looking forward to a bright future with reduced morbidity and mortality from HF.
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Affiliation(s)
- Bo Liang
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Yu-Xiu Zhao
- Hospital (T.C.M.) Affiliated to Southwest Medical University, Luzhou, China
| | | | - Hui-Ling Liao
- Hospital (T.C.M.) Affiliated to Southwest Medical University, Luzhou, China
- College of Integrated Traditional Chinese and Western Medicine, Southwest Medical University, Luzhou, China
| | - Ning Gu
- Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China.
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24
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McGuinty C, Leong D, Weiss A, MacIver J, Kaya E, Hurlburt L, Billia F, Ross H, Wentlandt K. Heart Failure: A Palliative Medicine Review of Disease, Therapies, and Medications With a Focus on Symptoms, Function, and Quality of Life. J Pain Symptom Manage 2020; 59:1127-1146.e1. [PMID: 31866489 DOI: 10.1016/j.jpainsymman.2019.12.357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 12/09/2019] [Accepted: 12/11/2019] [Indexed: 12/11/2022]
Abstract
Despite significant advances in heart failure (HF) treatment, HF remains a progressive, extremely symptomatic, and terminal disease with a median survival of 2.1 years after diagnosis. HF often leads to a constellation of symptoms, including dyspnea, fatigue, depression, anxiety, insomnia, pain, and worsened cognitive function. Palliative care is an approach that improves the quality of life of patients and their caregivers facing the problems associated with life-threatening illness and therefore is well suited to support these patients. However, historically, palliative care has often focused on supporting patients with malignant disease, rather than a progressive chronic disease such as HF. Predicting mortality in patients with HF is challenging. The lack of obvious transition points in disease progression also raises challenges to primary care providers and specialists to know at what point to integrate palliative care during a patient's disease trajectory. Although therapies for HF often result in functional and symptomatic improvements including health-related quality of life (HRQL), some patients with HF do not demonstrate these benefits, including those patients with a preserved ejection fraction. Provision of palliative care for patients with HF requires an understanding of HF pathogenesis and common medications used for these patients, as well as an approach to balancing life-prolonging and HRQL care strategies. This review describes HF and current targeted therapies and their effects on symptoms, hospital admission rates, exercise performance, HRQL, and survival. Pharmacological interactions with and precautions related to commonly used palliative care medications are reviewed. The goal of this review is to equip palliative care clinicians with information to make evidence-based decisions while managing the balance between optimal disease management and patient quality of life.
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Affiliation(s)
- Caroline McGuinty
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Derek Leong
- Department of Pharmacy, University Health Network, Toronto, Ontario, Canada
| | - Andrea Weiss
- Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, Ontario, Canada; Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jane MacIver
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ebru Kaya
- Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
| | - Lindsay Hurlburt
- Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, Ontario, Canada; Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Filio Billia
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Heather Ross
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kirsten Wentlandt
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, Ontario, Canada; Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
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25
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Koroma TR, Samura SK, Cheng Y, Tang M. Effect of Ivabradine on Left Ventricular Diastolic Function, Exercise Tolerance and Quality of Life in Patients With Heart Failure: A Systemic Review and Meta-Analysis of Randomized Controlled Trials. Cardiol Res 2020; 11:40-49. [PMID: 32095195 PMCID: PMC7011928 DOI: 10.14740/cr958] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 10/17/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Ivabradine is a heart rate-lowering drug that selectively inhibits the funny (If) current of the sinoatrial node. It is currently recommended in patients with heart failure (HF) with reduced ejection fraction (HFrEF) in sinus rhythm and a heart rate of ≥ 70 beats per minute (bpm) at rest. To investigate whether ivabradine has an effect on diastolic dysfunction, exercise tolerance and quality of life (QOL), we conducted a systemic review and meta-analysis of randomized controlled trials (RCTs). METHODS We searched PubMed, EMBASE and Cochrane Central Register of Clinical Trials for studies on the effect of ivabradine on left ventricular (LV) diastolic dysfunction, exercise tolerance, QOL, readmission for worsening HF and mortality in both patients with HF with preserved ejection fraction (HFpEF) and HFrEF. RESULTS Thirteen RCTs with 881 patients met the inclusion criteria. According to the pooled analysis, for the HFpEF subgroup, treatment with ivabradine resulted in a decrease in early diastolic mitral inflow to late diastolic flow ratio (E/A) (standardized mean difference (SMD): -0.53; 95% confidence interval (CI): -0.99, -0.07; P < 0.000) and increase in peak oxygen uptake during exercise (VO2) (SMD: 0.05; 95% CI: -0.35, 0.45; P < 0.00; I2 = 95.1%). Similar effect was seen in the HFrEF subgroup with decrease in E/A ratio (SMD: -0.33; 95% CI: -0.59, -0.06; P < 0.000) and early diastolic mitral inflow to annular velocity ratio (E/e') (SMD: -1.01; 95% CI: -1.49, -0.54; P < 0.012). Ivabradine therapy increased peak VO2 and 6-min walk test (6MWT) in HFrEF patients (SMD: 0.83; 95% CI: 0.35, 1.32; P < 0.00; I2 = 97.5% and SMD: 1.11; 95% CI: 0.82, 1.41; P < 0.000, respectively). There was also significant reduction in Minnesota Living with Heart Failure Questionnaire (MLHFQ) score (SMD: -0.68; 95% CI: -0.91, -0.45; P < 0.000). However, there was no significant difference in readmission for worsening HF and all-cause mortality between ivabradine and control (risk ratio (RR): 1.44; 95% CI: 0.73, 2.16; P < 0.148 and RR: 0.76; 95% CI: 0.19, 1.33; P < 0.907, respectively). CONCLUSIONS Ivabradine therapy is associated with improved LV diastolic function, increases exercise tolerance and hence QOL, but it has no significant effect on readmission for worsening HF and all-cause mortality.
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Affiliation(s)
- Theresa Ruba Koroma
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan, China
| | | | - Yuguo Cheng
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Mengxiong Tang
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan, China
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26
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Li H, Duan Y, Chen B, Zhao Y, Su W, Wang S, Wu J, Lu L. New pharmacological treatments for heart failure with reduced ejection fraction (HFrEF): A Bayesian network meta-analysis. Medicine (Baltimore) 2020; 99:e18341. [PMID: 32000355 PMCID: PMC7004768 DOI: 10.1097/md.0000000000018341] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Heart failure with reduced ejection fraction (HFrEF) has contributed to an increasing number of deaths and readmissions over the past few decades. Despite the appearance of standard treatments, including diuretics, β-receptor blockers and angiotensin-converting enzyme inhibitor (ACEI), there are still a large number of patients who have progressive deterioration of heart function and, inevitably, end-stage heart failure. In recent years, new medications for treating chronic heart failure have been clinically applied, but there is controversy surrounding drug selection and whether patients with HFrEF benefit from these medications. Therefore, we aimed to compare and rank different new pharmacological treatments in patients with HFrEF. METHODS We performed a network meta-analysis to identify both direct and indirect evidence from relevant studies. We searched MEDLINE, EMBASE, and PsycINFO through the OVID database and CENTRAL through the Cochrane Library for clinical randomized controlled trials investigating new pharmacological treatments in patients with HFrEF published up to September 30, 2018. We included trials of ivabradine, levosimendan, omega-3, tolvaptan, recombinant human B-type natriuretic peptide (rhBNP), isosorbide dinitrate and hydralazine (ISDN/HYD) and angiotensin-neprilysin inhibition (LCZ696). We extracted the relevant information from these trials with a predefined data extraction sheet and assessed the risk of bias with the Cochrane risk of bias tool. Based on these items, more than half of the entries were judged as having an overall low to moderate risk of bias; the remaining studies had a high or unclear risk of bias. The outcomes investigated were left ventricle ejection fraction (LVEF %), heart rate (HR) and serum level of B-type natriuretic peptide (BNP). We performed a random-effects network meta-analysis within a Bayesian framework. RESULTS We deemed 32 trials to be eligible that included 3810 patients and 32 treatments. Overall, 32 (94.1%) trials had a low to moderate risk of bias, while 2 (5.9%) trials had a high risk of bias. The quality of the included studies was rated as low in regard to allocation concealment and blinding and high in regard to other domains according to the Cochrane tools. As for increasing LVEF%, levosimendan was better than placebo (-3.77 (-4.96, -2.43)) and was the best intervention for improving ventricle contraction. As for controlling HR, n3-PUFA was better than placebo (4.01 (-0.44, 8.48)) and was the best choice for regulating HR. As for decreasing BNP, omega-3 was better than placebo (941.99 (-47.48, 1952.89) and was the best therapy for improving ventricle wall tension. CONCLUSIONS Our study confirmed the effectiveness of the included new pharmacological treatments for optimizing the structural performance and improving the cardiac function in the management of patients with HFrEF and recommended several interventions for clinical practice.
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Affiliation(s)
- Heng Li
- Cardiology Department of Tung Wah, Affiliated Hospital of Sun-Yat-Sen University
| | - Yuting Duan
- Clinical Research Center, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine
| | - Benfa Chen
- Cardiology Department of Tung Wah, Affiliated Hospital of Sun-Yat-Sen University
| | - Yu Zhao
- Cardiology Department of Tung Wah, Affiliated Hospital of Sun-Yat-Sen University
| | - Weiping Su
- Cardiology Department of Tung Wah, Affiliated Hospital of Sun-Yat-Sen University
| | - Shanhua Wang
- Cardiology Department of Tung Wah, Affiliated Hospital of Sun-Yat-Sen University
| | - Jiaming Wu
- Zhongshan Affiliated Hospital, Guangzhou University of Chinese Medicine, China
| | - Liming Lu
- Clinical Research Center, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine
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Belenkov YN, Ilgisonis IS, Naymann YI, Privalova EA, Zhito AV. [The Use of Selective Inhibitor of If-Channels Ivabradine in Patients with Ischemic Heart Disease, Heart Failure with High Heart Rate]. ACTA ACUST UNITED AC 2019; 59:60-65. [PMID: 31615388 DOI: 10.18087/cardio.2019.10.n601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 05/16/2019] [Indexed: 11/18/2022]
Abstract
Ischemic heart disease (IHD) and chronic heart failure (CHF) belong to leading causes of death among patients with cardiovascular diseases (CVD). Modern medical approaches to the treatment of patients with CHF do not always provide a significant improvement in the quality of life, a decrease in the frequency of CHF exacerbations and hospitalizations, and an improvement of the long-term prognosis. According to the neurohumoral theory of IHD and CHF development, the blockade of the sympathoadrenal system with β-adrenoblockers (β-AB) is pathogenetically substantiated, and preparations of this group are recommended as one of the main classes of drugs for the treatment of patients with CHF. However, selection of heart rhythm slowing therapy in patients with CHF of ischemic genesis is often difficult due to the development of undesirable side effects of β-AB, intolerance and/or due to the presence of contraindications for their use. Randomized studies have shown that prescribing a combination of β-AB and If-channel blocker ivabradine for heart rate (HR) reduction or solely ivabradine when use of β-AB is impossible in complex CHF therapy, improves the left ventricle (LV) diastolic function, reducing mortality from CHF decompensation. However, the prognostic significance of the use of ivabradine in patients with CHF with preserved left ventricular ejection fraction of ischemic genesis with heart rate higher than 70 beats/min receiving maximum tolerated doses of β-AB remains not fully investigated.
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Affiliation(s)
- Yu N Belenkov
- First Moscow State Medical University (Sechenov University)
| | - I S Ilgisonis
- First Moscow State Medical University (Sechenov University)
| | - Yu I Naymann
- First Moscow State Medical University (Sechenov University)
| | - E A Privalova
- First Moscow State Medical University (Sechenov University)
| | - A V Zhito
- First Moscow State Medical University (Sechenov University)
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Marzlin KM, Webner C. Chronotropic Incompetence. AACN Adv Crit Care 2019; 30:294-300. [PMID: 31462528 DOI: 10.4037/aacnacc2019182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Karen M Marzlin
- Karen M. Marzlin is Advanced Practice Registered Nurse, Aultman Hospital; Adjunct Faculty, Malone University; and Owner/Author/Educator/Consultant, Key Choice/Cardiovascular Nursing Education Associates, 4565 Venus Rd, Uniontown, OH 44685 . Cynthia Webner is Adjunct Faculty, Acute Care Nurse Practitioner Program, Malone University, Canton, Ohio; and Partner, Key Choice/Cardiovascular Nursing Education Associates, Uniontown, Ohio
| | - Cynthia Webner
- Karen M. Marzlin is Advanced Practice Registered Nurse, Aultman Hospital; Adjunct Faculty, Malone University; and Owner/Author/Educator/Consultant, Key Choice/Cardiovascular Nursing Education Associates, 4565 Venus Rd, Uniontown, OH 44685 . Cynthia Webner is Adjunct Faculty, Acute Care Nurse Practitioner Program, Malone University, Canton, Ohio; and Partner, Key Choice/Cardiovascular Nursing Education Associates, Uniontown, Ohio
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Zweerink A, van der Lingen ALCJ, Handoko ML, van Rossum AC, Allaart CP. Chronotropic Incompetence in Chronic Heart Failure. Circ Heart Fail 2019; 11:e004969. [PMID: 30354566 DOI: 10.1161/circheartfailure.118.004969] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Chronotropic incompetence (CI) is generally defined as the inability to increase the heart rate (HR) adequately during exercise to match cardiac output to metabolic demands. In patients with heart failure (HF), however, this definition is unsuitable because metabolic demands are unmatched to cardiac output in both conditions. Moreover, HR dynamics in patients with HF differ from those in healthy subjects and may be affected by β-blocking medication. Nevertheless, it has been demonstrated that CI in HF is associated with reduced functional capacity and poor survival. During exercise, the normal heart increases both stroke volume and HR, whereas in the failing heart, contractility reserve is lost, thus rendering increases in cardiac output primarily dependent on cardioacceleration. Consequently, insufficient cardioacceleration because of CI may be considered a major limiting factor in the exercise capacity of patients with HF. Despite the profound effects of CI in this specific population, the issue has drawn limited attention during the past years and is often overlooked in clinical practice. This might partly be caused by a lack of standardized approach to diagnose the disease, further complicated by changes in HR dynamics in the HF population, which render reference values derived from a normal population invalid. Cardiac implantable electronic devices (implantable cardioverter defibrillator; cardiac resynchronization therapy) now offer a unique opportunity to study HR dynamics and provide treatment options for CI by rate-adaptive pacing using an incorporated sensor that measures physical activity. This review provides an overview of disease mechanisms, diagnostic strategies, clinical consequences, and state-of-the-art device therapy for CI in HF.
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Affiliation(s)
- Alwin Zweerink
- Department of Cardiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, the Netherlands
| | | | - M Louis Handoko
- Department of Cardiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, the Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, the Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, the Netherlands
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Zhou Y, Wang J, Meng Z, Zhou S, Peng J, Chen S, Wang Q, Sun K. Pharmacology of Ivabradine and the Effect on Chronic Heart Failure. Curr Top Med Chem 2019; 19:1878-1901. [PMID: 31400267 DOI: 10.2174/1568026619666190809093144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 07/02/2019] [Accepted: 07/25/2019] [Indexed: 11/22/2022]
Abstract
Chronic Heart Failure (CHF) is a complex clinical syndrome with a high incidence worldwide. Although various types of pharmacological and device therapies are available for CHF, the prognosis is not ideal, for which, the control of increased Heart Rate (HR) is critical. Recently, a bradycardic agent, ivabradine, is found to reduce HR by inhibiting the funny current (If). The underlying mechanism states that ivabradine can enter the Hyperpolarization-activated Cyclic Nucleotide-gated (HCN) channels and bind to the intracellular side, subsequently inhibiting the If. This phenomenon can prolong the slow spontaneous phase in the diastolic depolarization, and thus, reduce HR. The clinical trials demonstrated the significant effects of the drug on reducing HR and improving the symptoms of CHF with fewer adverse effects. This review primarily introduces the chemical features and pharmacological characteristics of ivabradine and the mechanism of treating CHF. Also, some expected therapeutic effects on different diseases were also concluded. However, ivabradine, as a typical If channel inhibitor, necessitates additional research to verify its pharmacological functions.
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Affiliation(s)
- Yue Zhou
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Jian Wang
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Zhuo Meng
- Department of Pediatric Cardiology, the Second Affiliated Hospital&Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Shuang Zhou
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Jiayu Peng
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Sun Chen
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Qingjie Wang
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
| | - Kun Sun
- Department of Pediatric Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200092, China
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Pei H, Miao W, Xie WZ, Wang W, Zhao D, Su GH, Zhao Z. Ivabradine Improves Cardiac Function and Increases Exercise Capacity in Patients with Chronic Heart Failure. Int Heart J 2019; 60:899-909. [PMID: 31308326 DOI: 10.1536/ihj.18-559] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To systematically review and conduct a meta-analysis of the ivabradine-induced improvement in cardiopulmonary function, exercise capacity, and primary composite endpoints in patients with chronic heart failure (CHF).This study was a systematic review and meta-analysis.Databases, including PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Clinical Trials and European Union Clinical Trials, were searched for randomized placebo-controlled trials. The efficacy and safety of ivabradine treatment in patients with CHF were assessed and compared to those of the standard anti-heart failure treatment. Review Manager 5.3 software was used to analyze the relative risk (RR) for dichotomous data and the mean difference (MD) for continuous data.In total, 22 studies with 24,562 patients were included. Cardiopulmonary function analysis showed that treatment with added ivabradine reduced the heart rate (MD = -17.30, 95% confidence interval (CI): 19.52--15.08, P < 0.00001), significantly increased the left ventricular ejection fraction (LVEF) (MD = 3.90, 95% CI: 0.40-7.40, P < 0.0001), and led to a better New York Heart Association (NYHA) classification. Ivabradine significantly reduced the minute ventilation/carbon dioxide production (VE/VCO2) (MD = -2.68, 95% CI: -4.81--0.55, P = 0.01) and improved the peak VO2 (MD = 2.80, 95% CI: 1.05-4.55, P = 0.002) and the exercise capacity, including the exercise duration with a submaximal load (MD = 7.82, 95% CI: -2.57--18.21, P < 0.00001) and the 6-minute walk distance. The RR of cardiovascular death or worsening heart failure was significantly decreased (RR = 0.93, 95% CI: 0.87--0.98, P = 0.01) in the patients treated with ivabradine. Additionally, the RRs of heart failure and hospitalization also decreased (RR = 0.91, 95% CI: 0.85--0.97, P = 0.006; RR = 0.86, 95% CI: 0.79--0.93, P = 0.0002). Safety analysis showed no significant difference in the RR of severe adverse events between the ivabradine group and the standard anti-heart failure treatment group (P = 0.40). However, ivabradine significantly increased the RR of visual symptoms in CHF patients (RR = 3.82, 95% CI: 1.80--8.13, P = 0.0005).Existing evidence showed that adding ivabradine treatment significantly improved the cardiopulmonary function and increased the exercise capacity of patients with CHF. Adding ivabradine to the standard anti-heart failure treatment reduced the mortality and hospitalization risk and improved the quality of life. Finally, ivabradine significantly increased the RR of visual symptoms in CHF patients.This is the first systematic review and meta-analysis to focus on the efficacy of ivabradine, which improved the cardiac function and increased the exercise capacity in patients with chronic heart failure (CHF). Therefore, this study will help evaluate the quality of life after adding ivabradine to the treatment of patients with CHF, even though there are differences in the standard for resting heart rate, left ventricular ejection fraction (LVEF), and New York Heart Association (NYHA) class in the included studies. This hybrid effect might be smaller when analyzed separately but might have a higher heterogeneity when analyzed in multiple studies.
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Affiliation(s)
- Hui Pei
- Department of Cardiology, Jinan Central Hospital Affiliated with Shandong University.,Ti'an City Central Hospital
| | - Wei Miao
- Department of Cardiology, Jinan Central Hospital Affiliated with Shandong University
| | - Wen-Zhi Xie
- Department of Cardiology, Jinan Central Hospital Affiliated with Shandong University
| | - Wei Wang
- Department of Cardiology, Shandong Provincial Chest Hospital
| | - Di Zhao
- Department of Cardiology, Affiliated Hospital of Shandong Academy of Medical Sciences
| | - Guo-Hai Su
- Department of Cardiology, Jinan Central Hospital Affiliated with Shandong University
| | - Zhuo Zhao
- Department of Cardiology, Jinan Central Hospital Affiliated with Shandong University
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Affiliation(s)
- Edimar Alcides Bocchi
- Heart Failure Team, Heart Institute (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vera Maria Cury Salemi
- Heart Failure Team, Heart Institute (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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The CARVIVA HF trial- Is the devil in the detail? Int J Cardiol 2019; 274:260. [DOI: 10.1016/j.ijcard.2018.07.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 07/31/2018] [Indexed: 11/20/2022]
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Guzman M, Gomez R, Romero SP, Aranda R, Andrey JL, Pedrosa MJ, Egido J, Gomez F. Prognosis of heart failure treated with digoxin or with ivabradine: A cohort study in the community. Int J Clin Pract 2018; 72:e13217. [PMID: 30248211 DOI: 10.1111/ijcp.13217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/09/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Resting heart rate (HR) reduction with ivabradine (IVA) improves outcomes of patients with heart failure and reduced ejection fraction (HFrEF). Nevertheless, the best option to slow HR in patients with HFrEF treated with beta-blockers and a HR >70 bpm is unsettled. AIMS To evaluate whether, in patients with HFrEF, commencing therapy with digoxin (CT-DIG) is associated to a worse prognosis than commencing treatment with ivabradine (CT-IVA). METHODS Observational study over 10 years on 2364 patients with HFrEF in sinus rhythm and a HR >70 bpm. Main outcomes were mortality, hospitalisations and visits. We analyse the independent relationship of CT-DIG or CT-IVA with the prognosis, stratifying patients for cardiovascular comorbidity, and for other potential confounders (378 patients who CT-DIG vs another 355 patients who CT-IVA vs another 1631 patients non-exposed to IVA or DIG). RESULTS During a median follow-up of 57.5 months, 1751 patients (74.1%) died, and 2151 (91.0%) were hospitalised for HF. CT-DIG or CT-IVA was associated with a lower all-cause mortality (DIG: HR = 0.86 [95% CI, 0.82-0.90], and IVA: HR = 0.88 [0.83-0.93]), cardiovascular mortality (DIG: HR = 0.84 [0.80-0.89] and IVA: HR = 0.83 [0.78-0.89]), hospitalisation (DIG: HR = 0.86 [0.83-0.89] and IVA: HR = 0.87 [0.83-0.91]) and 30-day readmission (DIG: HR = 0.84 [0.79-0.90] and IVA: HR = 0.88 [0.79-0.95]), after adjustment for cardiovascular comorbidity, and other potential confounders. These associations with the prognosis of HFrEF did not differ between patients who CT-DIG and those who CT-IVA. CONCLUSION Commencing therapy with digoxin or with ivabradine is associated with an improved prognosis of patients with HFrEF.
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Affiliation(s)
- Marcos Guzman
- Department of Medicine, School of Medicine, Hospital Universitario Puerto Real, University of Cadiz, Cadiz, Spain
| | - Rocio Gomez
- Department of Medicine, School of Medicine, Hospital Universitario Puerto Real, University of Cadiz, Cadiz, Spain
| | - Sotero P Romero
- Department of Medicine, School of Medicine, Hospital Universitario Puerto Real, University of Cadiz, Cadiz, Spain
| | - Rocio Aranda
- Department of Medicine, School of Medicine, Hospital Universitario Puerto Real, University of Cadiz, Cadiz, Spain
| | - Jose L Andrey
- Department of Medicine, School of Medicine, Hospital Universitario Puerto Real, University of Cadiz, Cadiz, Spain
| | - Maria J Pedrosa
- Department of Medicine, School of Medicine, Hospital Universitario Puerto Real, University of Cadiz, Cadiz, Spain
| | - Julio Egido
- Department of Medicine, School of Medicine, Hospital Universitario Puerto Real, University of Cadiz, Cadiz, Spain
| | - Francisco Gomez
- Department of Medicine, School of Medicine, Hospital Universitario Puerto Real, University of Cadiz, Cadiz, Spain
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Patel PA, Ali N, Roy A, Pinder S, Cubbon RM, Kearney MT, Witte KK. Effects of Ivabradine on Hemodynamic and Functional Parameters in Left Ventricular Systolic Dysfunction: a Systematic Review and Meta-analysis. J Gen Intern Med 2018; 33:1561-1570. [PMID: 30022413 PMCID: PMC6108989 DOI: 10.1007/s11606-018-4578-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/05/2018] [Accepted: 07/02/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Ivabradine is licensed as add-on therapy in patients with severe left ventricular systolic dysfunction (LVSD), normal sinus rhythm, and suboptimal heart rate (HR) control, but effects are not fully established. This study sought to assess the impact of ivabradine therapy on hemodynamic and functional outcome measures in all patients with LVSD. METHODS MEDLINE (1996-2017), Embase (1996-2017), Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, ClinicalTrials.gov , and ISI Web of Science were searched for randomized clinical trials (RCTs) comparing standard medical therapy (SMT) plus ivabradine to SMT alone for patients with LVSD of any severity. Each trial was assessed using the Cochrane Collaborations Risk of Bias tool. RESULTS Eight RCTs with 17,823 patients were included. Add-on use of ivabradine reduced resting HR (mean difference [MD] 10.3 bpm; p < 0.001), improved ejection fraction (EF) (MD 3.6%, p < 0.001), and preserved systolic blood pressure (MD 3.4 mmHg; p = 0.09). Stratified analyses according to severity of LVSD did not influence conferred benefits on HR and EF. Small improvements were noted in exercise tolerance (standardized MD 5.9 s; p = 0.004) and peak oxygen consumption (MD 2.9 ml/kg/min; p = 0.02). DISCUSSION Adjunct therapy with ivabradine in patients with LVSD results in a favorable hemodynamic profile and correlates with improved functional capacity. Benefits appear to be broadly preserved irrespective of baseline EF. This was a meta-analysis of RCTs, though limited by exclusion of post hoc analyses, lack of access to patient level data, and inter-study variability in some baseline characteristics. Further, large-scale RCTs are warranted to evaluate effectiveness of ivabradine in cohorts with non-severe LVSD.
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Affiliation(s)
- Peysh A Patel
- Department of Cardiology, Leeds General Infirmary, Leeds, UK.
| | - Noman Ali
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
| | - Ashwin Roy
- Department of Cardiology, Tameside General Hospital, Greater Manchester, UK
| | - Stuart Pinder
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
| | | | - Mark T Kearney
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
| | - Klaus K Witte
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
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Hartmann C, Bosch NL, de Aragão Miguita L, Tierie E, Zytinski L, Baena CP. The effect of ivabradine therapy on heart failure patients with reduced ejection fraction: a systematic review and meta-analysis. Int J Clin Pharm 2018; 40:1443-1453. [PMID: 30173307 DOI: 10.1007/s11096-018-0715-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 08/09/2018] [Indexed: 12/20/2022]
Abstract
Background Ivabradine is currently indicated to lower heart rate in Heart Failure with Reduced Ejection Fraction (HFrEF) patients. However its effect apart from beta-blockers is not clear. Aim of the review To study the additional effect of ivabradine, apart from the effect of beta-blockers, on cardiovascular death, all-cause mortality, hospitalization due to HF and heart rate in HFrEF population. Method Electronic searches were conducted up to June 2016 to include randomized controlled trials where ivabradine was compared to a control group. Relative risks RRs and their 95% confidence intervals (CI 95%) were pooled and the random and fixed effect were used to summarize the results according to heterogeneity levels. Heterogeneity among studies was measured by the I-squared statistic Results Of 1790 studies, seven met the inclusion criteria for the systematic review and meta-analysis. The population consisted of 17,747 patients. Risk of bias was generally high for beta-blocker doses lower than recommended. Interventions lasted 1.5-22.9 months and pooled relative risks RR (95%) for all-cause mortality, cardiovascular death and hospitalization for HF were 0.98 (0.90-1.06); 0.99 (0.91-1.08); and 0.87 (0.68-1.12) respectively. Heart rate (CI 95%) decreased by 8.7 (6.37-11.03) beats per minute with ivabradine compared to the control group. Subgroup analysis by beta-blocker dose showed that for patients on recommended treatment (at least 50% of the beta-blocker target dose), heart rate (CI 95%) decreased by 4.70 (3.67-5.73), whereas for patients not on recommended treatment or with unreported dose, heart rate decreased by 8.60 (8.13-9.08). Conclusion Ivabradine significantly reduced heart rate and its additional effect on heart rate appears to be inversely correlated with the dose of beta-blocker. It showed no significant effect for all-cause mortality, cardiovascular death and hospitalization due to HF. Unreported beta-blocker doses and beta-blocker doses lower than recommended limited the conclusions.
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Affiliation(s)
- Camila Hartmann
- Pontificia Universidade Católica do Paraná, Curitiba, Brazil
| | | | | | - Elise Tierie
- Pontificia Universidade Católica do Paraná, Curitiba, Brazil.,Erasmus MC, Rotterdam, The Netherlands
| | - Lídia Zytinski
- Pontificia Universidade Católica do Paraná, Curitiba, Brazil
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Inampudi C, Alvarez P, Asleh R, Briasoulis A. Therapeutic Approach to Patients with Heart Failure with Reduced Ejection Fraction and End-stage Renal Disease. Curr Cardiol Rev 2018; 14:60-66. [PMID: 29366423 PMCID: PMC5872264 DOI: 10.2174/1573403x14666180123164916] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 01/11/2018] [Accepted: 01/15/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Several risk factors including Ischemic heart disease, uncontrolled hypertension, high output Heart Failure (HF) from shunting through vascular hemodialysis access, and anemia, contribute to development of HF in patients with End-Stage Renal Disease (ESRD). Guidelinedirected medical and device therapy for Heart Failure with Reduced Ejection Fraction (HFrEF) has not been extensively studied and may have limited safety and efficacy in patients with ESRD. RESULTS Maintenance of interdialytic and intradialytic euvolemia is a key component of HF management in these patients but often difficult to achieve. Beta-blockers, especially carvedilol which is poorly dialyzed is associated with cardiovascular benefit in this population. Despite paucity of data, Angiotensin-converting Enzyme Inhibitors (ACEI) or Angiotensin II Receptor Blockers (ARBs) when appropriately adjusted by dose and with close monitoring of serum potassium can also be administered to these patients who tolerate beta-blockers. Mineralocorticoid receptors in patients with HFrEF and ESRD have been shown to reduce mortality in a large randomized controlled trial without any significantly increased risk of hyperkalemia. Implantable Cardiac-defibrillators (ICDs) should be considered for primary prevention of sudden cardiac death in patients with HFrEF and ESRD who meet the implant indications. Furthermore in anemic iron-deficient patients, intravenous iron infusion may improve functional status. Finally, mechanical circulatory support with leftventricular assist devices may be related to increased mortality risk and the presence of ESRD poses a relative contraindication to further evaluation of these devices.
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Affiliation(s)
- Chakradhari Inampudi
- Division of Cardiovascular Diseases, Section of Heart Failure and Transplant, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Paulino Alvarez
- Division of Cardiovascular Diseases, Section of Heart Failure and Transplant, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Rabea Asleh
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester MN, United States
| | - Alexandros Briasoulis
- Division of Cardiovascular Diseases, Section of Heart Failure and Transplant, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
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Bonadei I, Sciatti E, Vizzardi E, Fabbricatore D, Pagnoni M, Rossi L, Carubelli V, Lombardi CM, Metra M. Effects of ivabradine on endothelial function, aortic properties and ventricular-arterial coupling in chronic systolic heart failure patients. Cardiovasc Ther 2018; 36:e12323. [PMID: 29460403 DOI: 10.1111/1755-5922.12323] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 12/30/2017] [Accepted: 02/15/2018] [Indexed: 12/28/2022] Open
Abstract
AIM Heart rate (HR) is an important prognostic factor in patients affected by chronic heart failure (CHF); ivabradine has been demonstrated to significantly reduce nonfatal myocardial infarction and hospitalization rate for acute heart failure and to improve left ventricular (LV) reverse remodeling, quality of life, exercise capacity, and arterial elastance (Ea) in these patients. We aimed at evaluating the short-term effects of ivabradine on ventricular-arterial coupling (VAC), aortic stiffness, and endothelial function in stable patients with CHF. METHODS We evaluated 30 consecutive CHF patients (LVEF≤ 35%, NYHA class II) with sinus rhythm and HR ≥ 70 bpm on optimized pharmacological therapy. All of them underwent both transthoracic echocardiogram to assess aortic elastic properties (aortic distensibility, AD; aortic stiffness index, ASI; systolic aortic strain, SAS) and VAC, and peripheral arterial tonometry to measure endothelial function. Therapy with ivabradine 5 mg bid was added and each patient was evaluated with the same examinations after 4 months. RESULTS At the baseline, 73% of patients had impaired VAC and 63% endothelial dysfunction. After 4 months, there was a significant improvement in the VAC value (ΔVAC -0.10 ± 0.18, P = .021), mainly linked to Ea (ΔEa -0.40 ± 0.23 mm Hg/mL; P = .003). All the parameters of aortic elasticity underwent significant improvement (ΔAD 1.82 ± 1.43 cm² × dyn- ¹, P = .004; ΔASI -4.73 ± 6.07, P = .033; ΔSAS -7.98 ± 4.37%, P = .003). Lastly, we also noted a significant improvement of endothelial function (Δ RHI 0.35 ± 0.35; P < .001). At follow-up 40% of patients had impaired VAC (P = .018) and 33% endothelial dysfunction (P = .038). CONCLUSION In patients with CHF adding ivabradine on top to the standard optimized medical therapy, when indicated, seems to improve endothelial function, aortic properties, and VAC.
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Affiliation(s)
- Ivano Bonadei
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
| | - Edoardo Sciatti
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
| | - Enrico Vizzardi
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
| | | | - Mattia Pagnoni
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
| | - Laura Rossi
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
| | | | - Carlo M Lombardi
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
| | - Marco Metra
- Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy
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Role of the Funny Current Inhibitor Ivabradine in Cardiac Pharmacotherapy: A Systematic Review. Am J Ther 2018; 25:e247-e266. [DOI: 10.1097/mjt.0000000000000388] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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42
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Vitale C, Ilaria S, Rosano GM. Pharmacological Interventions Effective in Improving Exercise Capacity in Heart Failure. Card Fail Rev 2018; 4:25-27. [PMID: 29892472 DOI: 10.15420/cfr.2018:8:2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Heart failure (HF) is characterised by exercise intolerance, which substantially impairs quality of life (QOL) and prognosis. The aim of this review is to summarise the state of the art on pharmacological interventions that are able to improve exercise capacity in HF. Ivabradine, trimetazidine and intravenous iron are the only drugs included in the European Society of Cardiology HF guidelines that have consistently been shown to positively affect functional capacity in HF. The beneficial effects on HF symptoms, physical performance and QOL using these pharmacological approaches are described.
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Affiliation(s)
- Cristiana Vitale
- Centre for Clinical and Basic Research, Department of Medical Sciences, IRCCS San Raffaele Pisana Rome, Italy
| | - Spoletini Ilaria
- Centre for Clinical and Basic Research, Department of Medical Sciences, IRCCS San Raffaele Pisana Rome, Italy
| | - Giuseppe Mc Rosano
- Centre for Clinical and Basic Research, Department of Medical Sciences, IRCCS San Raffaele Pisana Rome, Italy
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43
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Biffi M, Massaro G, Candelora A, Angeletti A, Valzania C, Martignani C, Grassini D, Diemberger I, Ziacchi M. Less is more: Can we achieve cardiac resynchronization with 2 leads only? Int J Cardiol 2017; 249:184-190. [DOI: 10.1016/j.ijcard.2017.09.189] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/17/2017] [Accepted: 09/22/2017] [Indexed: 10/18/2022]
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Heart rate manipulation in dilated cardiomyopathy: Assessing the role of Ivabradine. Indian Heart J 2017; 70:246-251. [PMID: 29716702 PMCID: PMC5993928 DOI: 10.1016/j.ihj.2017.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 07/27/2017] [Accepted: 08/10/2017] [Indexed: 01/06/2023] Open
Abstract
Background Heart rate (HR) reduction is of benefit in chronic heart failure (HF). The effect of heart rate reduction using Ivabradine on various echocardiographic parameters in dilated cardiomyopathy has been less investigated. Methods Of 187 patients with HF (DCM, NYHA II–IV, baseline HR > 70/min), 125 patients were randomized to standard therapy (beta blockers, ACEI, diuretics, n = 62) or add-on Ivabradine (titrated to maximum 7.5 mg BD, n = 63). Beta-blockers were titrated in both the groups. Results At 3 months both groups had improvement in NYHA class, 6 min walk test, Minnesota Living With Heart Failure (MLWHF) scores and fall in BNP, however the magnitude of change was greater in Ivabradine group. Those on Ivabradine also had lower LV volumes, higher LVEF (28.8 ± 3.6 vs 27.2 ± 0.5, p = 0.01) and more favorable LV global strain (11 ± 1.7vs 12.2 ± 1.1, p = <0.001), MPI (0.72 ± 0.1 vs 0.6 ± 0.1, p = <0.001), LV mass (115.2 ± 30 vs 131.4 ± 35, p = 0.007), LV wall stress (219.8 ± 46 vs 238 ± 54) and calculated LV work (366 ± 101 vs 401 ± 102, p = 0.05). The benefit of Ivabradine was sustained at 6 months follow up. The % change in HR was significantly higher in Ivabradine group (−32.2% vs −19.3%, p = 0.001) with no difference in blood pressure. Resting HR < 70/min was achieved in 96.8% vs 27.9%, respectively in the two groups. Conclusion Addition of Ivabradine to standard therapy in patients with DCM and symptomatic HF and targeting a heart rate < 70/min improves symptoms, quality of life and various echocardiographic parameters.
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45
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Long-term treatment with ivabradine over 12 months in patients with chronic heart failure in clinical practice: Effect on symptoms, quality of life and hospitalizations. Int J Cardiol 2017; 240:258-264. [DOI: 10.1016/j.ijcard.2017.03.131] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/28/2017] [Indexed: 11/18/2022]
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Morrical BD, Anderson JH, Taggart NW. Exercise Capacity Before and After Stent Placement for Coarctation of the Aorta: A Single-Center Case Series. Pediatr Cardiol 2017; 38:1143-1147. [PMID: 28523342 DOI: 10.1007/s00246-017-1628-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 05/09/2017] [Indexed: 10/19/2022]
Abstract
Over the last 15 years, stent placement has become a viable and safe alternative to surgical repair for native and recurrent coarctation of the aorta. Although patients with coarctation of the aorta often have lower exercise tolerance, there is no published data regarding the effect of coarctation stenting on exercise capacity. We aimed to determine the effect of coarctation stent placement on exercise capacity. We conducted a retrospective chart review of all patients who underwent stent placement for native or recurrent coarctation of the aorta at our institution from January 2000 to October 2012. We identified those patients who underwent exercise testing before and after stent placement. We compared measures of exercise capacity pre- and post-stent placement using paired t tests. Among 48 patients who underwent coarctation stenting, 7 (mean age = 40, range 21-65 years) were found to have isolated coarctation of the aorta and had the necessary pre- and post-stent exercise data. Only one patient had native coarctation of the aorta. The peak-to-peak systolic gradient improved by a mean of 26 mmHg (p < 0.02) after stent placement. Functional aerobic capacity (FAC) improved from a mean of 69-83% after stent placement (p < 0.03). Metabolic equivalents (METs) also improved significantly from a mean of 8.7 to 10.2 (p < 0.03). In our cohort, stent placement for relief of recurrent coarctation of the aorta resulted in a significant improvement in exercise capacity. This improvement may not be as significant in patients with milder coarctation of the aorta or those with complicating morbidities. Larger studies with more long-term follow-up are needed to better quantify this improvement and to define any lasting effect of this intervention on exercise tolerance.
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Affiliation(s)
| | - Jason H Anderson
- Department of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA
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47
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Thorup L, Simonsen U, Grimm D, Hedegaard ER. Ivabradine: Current and Future Treatment of Heart Failure. Basic Clin Pharmacol Toxicol 2017; 121:89-97. [DOI: 10.1111/bcpt.12784] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/21/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Lene Thorup
- Department of Biomedicine, Pharmacology; Aarhus University; Aarhus Denmark
| | - Ulf Simonsen
- Department of Biomedicine, Pharmacology; Aarhus University; Aarhus Denmark
| | - Daniela Grimm
- Department of Biomedicine, Pharmacology; Aarhus University; Aarhus Denmark
| | - Elise R. Hedegaard
- Department of Biomedicine, Pharmacology; Aarhus University; Aarhus Denmark
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48
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Anantha Narayanan M, Reddy YNV, Baskaran J, Deshmukh A, Benditt DG, Raveendran G. Ivabradine in the treatment of systolic heart failure - A systematic review and meta-analysis. World J Cardiol 2017; 9:182-190. [PMID: 28289533 PMCID: PMC5329746 DOI: 10.4330/wjc.v9.i2.182] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/07/2017] [Accepted: 01/16/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To perform a systematic-review and meta-analysis to compare outcomes of ivabradine combined with beta-blocker to beta-blocker alone in heart failure with reduced ejection fraction (HFrEF). METHODS We searched PubMed, Cochrane, EMBASE, CINAHL and Web of Science for trials comparing ivabradine + beta-blocker to beta-blocker alone in HFrEF. We performed a systematic-review and meta-analysis of published literature. Primary end-point was combined end point of cardiac death and hospitalization for heart failure. RESULTS Six studies with 17671 patients were included. Mean follow-up was 8.7 ± 7.9 mo. Combined end-point of heart failure readmission and cardiovascular death was better in ivabradine + beta-blocker group compared to beta-blocker alone (RR: 0.93, 95%CI: 0.79-1.09, P = 0.354). Mean difference (MD) in heart rate was higher in the ivabradine + beta-blocker group (MD: 6.14, 95%CI: 3.80-8.48, P < 0.001). There was no difference in all cause mortality (RR: 0.98, 95%CI: 0.89-1.07, P = 0.609), cardiovascular mortality (RR: 0.99, 95%CI: 0.86-1.15, P = 0.908) or heart failure hospitalization (RR: 0.87, 95%CI: 0.68-1.11, P = 0.271). CONCLUSION From the available clinical trials, ivabradine + beta-blocker resulted in a significantly greater reduction in HR coupled with improvement in combined end-point of heart failure readmission and cardiovascular death but with no improvement in all cause or cardiovascular mortality. Given the limited evidence, further randomized controlled trials are essential before widespread clinical application of ivabradine + beta-blocker is advocated for HFrEF.
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Affiliation(s)
- Mahesh Anantha Narayanan
- Mahesh Anantha Narayanan, Janani Baskaran, David G Benditt, Ganesh Raveendran, Division of Cardiovascular Diseases, University of Minnesota Medical Center, Minneapolis, MN 55455, United States
| | - Yogesh N V Reddy
- Mahesh Anantha Narayanan, Janani Baskaran, David G Benditt, Ganesh Raveendran, Division of Cardiovascular Diseases, University of Minnesota Medical Center, Minneapolis, MN 55455, United States
| | - Janani Baskaran
- Mahesh Anantha Narayanan, Janani Baskaran, David G Benditt, Ganesh Raveendran, Division of Cardiovascular Diseases, University of Minnesota Medical Center, Minneapolis, MN 55455, United States
| | - Abhishek Deshmukh
- Mahesh Anantha Narayanan, Janani Baskaran, David G Benditt, Ganesh Raveendran, Division of Cardiovascular Diseases, University of Minnesota Medical Center, Minneapolis, MN 55455, United States
| | - David G Benditt
- Mahesh Anantha Narayanan, Janani Baskaran, David G Benditt, Ganesh Raveendran, Division of Cardiovascular Diseases, University of Minnesota Medical Center, Minneapolis, MN 55455, United States
| | - Ganesh Raveendran
- Mahesh Anantha Narayanan, Janani Baskaran, David G Benditt, Ganesh Raveendran, Division of Cardiovascular Diseases, University of Minnesota Medical Center, Minneapolis, MN 55455, United States
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Erdem FH, Ozturk S, Öztürk S, Erdem A, Ayhan S, Öztürk M, Dönmez İ, Baltacı D, Yazıcı M. The Effects of Ivabradine on Left Ventricular Synchronization and Tei Index in Patients with Systolic Heart Failure. ACTA CARDIOLOGICA SINICA 2017; 33:58-65. [PMID: 28115808 PMCID: PMC5241437 DOI: 10.6515/acs20160205b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 02/05/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND The aim of our study was to evaluate in stable outpatients with systolic heart failure (HF) the 3 months effect of ivabradine on LV synchronization and Tei index in stable outpatients with systolic HF. METHODS We evaluated prospectively 40 (30 males, 10 females) patients with HF. All patients were evaluated before and after treatment by transthoracic M mode, two dimensional (2D), pulsed-wave (PW), continuous wave (CW), color flow and tissue Doppler imaging (TDI) and tissue synchronization imaging (TSI). Standard deviation of Ts of the 12 LV segments (Ts-SD-12) is the most widely used parameter of intra-LV asynchrony. RESULTS Thirty men and 10 women with mean ± SD age of 64.7 ± 9.9 years were included in this study. Most of the patients benefitted from some degree of clinical improvement, 12/16 (75.0%) from NYHA III to II and 18/24 (75.0%) from II to I, respectively. Resting heart rate was significantly reduced after ivabradine treatment (84.3 ± 11.4 vs. 66.5 ± 11.5 bpm, p < 0.001). E/E' and Tei index were significantly changed after ivabradine treatment (17.3 ± 9.0 vs. 14.8 ± 7.1, p = 0.02 and 0.86 ± 0.74 vs. 0.81 ± 0.69, p = 0.02). Intra-LV synchrony parameters Ts-SD-12 and Ts-12 were significantly reduced after ivabradine (46.8 ± 13.6 vs. 42.7 ± 13.1, p = 0.01 and 142.5 ± 44.0 vs. 128.5 ± 45.2, p = 0.009). CONCLUSIONS The present study demonstrated that adding ivabradine to the standard therapy reduced HR and significantly improved LV ventricular asynchrony and Tei index in systolic HF patients.
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Affiliation(s)
- Fatma Hizal Erdem
- Department of Cardiology, Faculty of Medicine, Abant Izzet Baysal University, Bolu
| | - Serkan Ozturk
- Department of Cardiology, Faculty of Medicine, Abant Izzet Baysal University, Bolu
| | - Selçuk Öztürk
- Department of Cardiology, Faculty of Medicine, Abant Izzet Baysal University, Bolu
| | - Alim Erdem
- Department of Cardiology, Faculty of Medicine, Abant Izzet Baysal University, Bolu
| | - Selim Ayhan
- Department of Cardiology, Faculty of Medicine, Abant Izzet Baysal University, Bolu
| | | | - İbrahim Dönmez
- Department of Cardiology, Faculty of Medicine, Abant Izzet Baysal University, Bolu
| | - Davut Baltacı
- Family Medicine, Faculty of Medicine, Duzce University, Duzce, Turkey
| | - Mehmet Yazıcı
- Department of Cardiology, Faculty of Medicine, Abant Izzet Baysal University, Bolu
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Iellamo F, Werdan K, Narkiewicz K, Rosano G, Volterrani M. Practical Applications for Single Pill Combinations in the Cardiovascular Continuum. Card Fail Rev 2017; 3:40-45. [PMID: 28785474 DOI: 10.15420/cfr.2017:5:1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Despite the availability of new drugs and devices, the treatment of cardiovascular disease remains suboptimal. Single-pill combination therapy offers a number of potential advantages. It can combine different classes of drugs to increase efficacy while mitigating the risks of treatment-related adverse events, reduce pill burden, lower medical cost, and improve patient adherence. Furthermore, in hypertension, single pill combinations include standard to lower doses of each drug than would be necessary to achieve goals with monotherapy, which may explain their better tolerability compared with higher dose monotherapy. Combination therapy is now established in the treatment of hypertension. In ischaemic heart disease, the concept of a preventative polypill has been studied, but its benefits have not been established conclusively. However, the combination of ivabradine and beta-blockers has proven efficacy in patients with stable angina pectoris. This combination has also demonstrated benefits in patients with chronic heart failure.
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Affiliation(s)
- Ferdinando Iellamo
- Dipartimento di Scienze Mediche, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Pisana, Rome, Italy.,Department of Clinical Science and Translational Medicine, University Tor Vergata, Rome, Italy
| | - Karl Werdan
- Department of Medicine III, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology Medical University of Gdansk, Gdansk, Poland
| | - Giuseppe Rosano
- Dipartimento di Scienze Mediche, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Pisana, Rome, Italy.,St George's University of London, London, UK
| | - Maurizio Volterrani
- Dipartimento di Scienze Mediche, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Pisana, Rome, Italy
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