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Ashraf S, Khalaf AKS, Fatima L, Hashim HT, Irfan H, Ashfaq H, Khan MA, Zahid A, Akram U, Goyal A. Evaluating the role of ivabradine in acute decompensated heart failure: A systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102604. [PMID: 38729277 DOI: 10.1016/j.cpcardiol.2024.102604] [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: 04/19/2024] [Revised: 04/21/2024] [Accepted: 04/28/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Acute decompensated heart failure (ADHF) presents a significant global health challenge, with high morbidity, mortality, and healthcare costs. The current therapeutic options for ADHF are limited. Ivabradine, a selective inhibitor of hyperpolarization-activated cyclic nucleotide-gated (HCN) channels, has emerged as a potential therapy for ADHF by reducing the heart rate (HR) without negatively affecting myocardial contractility. However, the evidence regarding the efficacy and safety of ivabradine in patients with ADHF is limited and inconsistent. This meta-analysis aimed to evaluate the efficacy and safety of ivabradine for ADHF based on observational studies. METHODS A systematic literature search was conducted following PRISMA guidelines to identify relevant observational studies comparing ivabradine with placebo in adult patients with ADHF. Data were pooled using a random-effects model, and heterogeneity was assessed. The risk of bias was evaluated using the Newcastle-Ottawa Scale. RESULTS Four observational studies comprising a total of 12034 patients. Meta-analysis revealed that ivabradine significantly reduced all-cause mortality (RR: 0.66, 95 % CI: 0.49-0.89, p < 0.01) and resting HR (MD: -12.54, 95 % CI: -21.66-3.42, p < 0.01) compared to placebo. However, no significant differences were observed in cardiovascular mortality, hospital readmission for all causes, changes in LVEF, or changes in LVEDD. Sensitivity and publication bias assessments were conducted for each outcome. CONCLUSION Ivabradine may be beneficial for reducing mortality and HR in patients with ADHF. However, its impact on other clinical outcomes such as cardiovascular mortality, hospital readmission, and cardiac function remains inconclusive. Further research, particularly well-designed RCTs with larger sample sizes and longer follow-up durations, are warranted.
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Affiliation(s)
- Saad Ashraf
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Laveeza Fatima
- Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | - Hashim Talib Hashim
- Department of Internal Medicine, University of Warith Al-Anbiyaa, College of Medicine, Karbala, Iraq
| | - Hamza Irfan
- Department of Internal Medicine, Shaikh Khalifa Bin Zayed Al Nahyan Medical and Dental College, Lahore, Pakistan
| | - Haider Ashfaq
- Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | - Maryam Ahmed Khan
- Department of Internal Medicine, Fazaia Medical College, Islamabad, Pakistan
| | - Arhamah Zahid
- Department of Internal Medicine, Fazaia Medical College, Islamabad, Pakistan
| | - Umar Akram
- Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | - Aman Goyal
- Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Acharya Donde Marg, Parel, Mumbai 400012, India.
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Alcaraz-Guzmán A, Amaro-Palomo EJ, Ruiz-Beltrán AM, Díaz-Herrera BÁ, Neri-Bale RR, Hernández-Bravo L, Candia-Ramírez MA, Gopar-Nieto R, González-Pacheco H, Sierra-Lara Martinez JD, Arias-Mendoza A, Araiza-Garaygordobil D. A randomized controlled trial of ivabradine in patients with acute myocardial infarction related cardiogenic shock. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2024; 5:e342. [PMID: 39015193 PMCID: PMC11247970 DOI: 10.47487/apcyccv.v5i2.342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/15/2024] [Indexed: 07/18/2024]
Abstract
Objective . Acute myocardial infarction-related cardiogenic shock (AMI-CS) is often accompanied by tachycardia, which, in turn, increases myocardial oxygen consumption and hinders the use of ventricular assist devices, such as intra-aortic balloon pump. Evidence suggests that ivabradine may reduce heart rate (HR) without affecting other hemodynamic parameters. The aim of the present study was to determine the effect of ivabradine on reducing HR and changes in other hemodynamic parameters such as cardiac index (CI), in patients with AMI-CS and tachycardia. Materials and methods . A single-center, open label, randomized clinical trial included patients diagnosed with AMI-CS and tachycardia with >100 beats per minute (BPM). Heart rate, cardiac index, and other hemodynamic parameters measured by pulmonary flotation catheter were compared at 0, 6, 12, 24, and 48 hours after randomization. Results . A total of 12 patients were randomized; 6 received standard therapy, and 6 received ivabradine in addition to standard therapy. Baseline clinical characteristics were similar at randomization. A statistically significant lower heart rate was found at 12 hours (p=0.003) and 48 hours (p=0.029) after randomization, with differences of -23.3 (-8.2 to -38.4) BPM and -12.6 (-0.5 to -25.9) BPM, respectively. No differences in cardiac index, or any other evaluated hemodynamic parameters, length of hospital stay, nor mortality rate were noted between both groups. Conclusions . The use of ivabradine in patients with AMI-CS was associated with a significant reduction in heart rate at 12 and 48 h, without affecting other hemodynamic parameters.
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Affiliation(s)
- Alejandro Alcaraz-Guzmán
- Coronary Care Unit, National Institute of Cardiology “Ignacio Chávez”, Mexico City, Mexico.Coronary Care UnitNational Institute of Cardiology “Ignacio Chávez”Mexico CityMexico
| | - Eder Jonathan Amaro-Palomo
- Coronary Care Unit, National Institute of Cardiology “Ignacio Chávez”, Mexico City, Mexico.Coronary Care UnitNational Institute of Cardiology “Ignacio Chávez”Mexico CityMexico
| | - Arturo Maximiliano Ruiz-Beltrán
- Coronary Care Unit, National Institute of Cardiology “Ignacio Chávez”, Mexico City, Mexico.Coronary Care UnitNational Institute of Cardiology “Ignacio Chávez”Mexico CityMexico
| | - Braiana Ángeles Díaz-Herrera
- Coronary Care Unit, National Institute of Cardiology “Ignacio Chávez”, Mexico City, Mexico.Coronary Care UnitNational Institute of Cardiology “Ignacio Chávez”Mexico CityMexico
| | - Raúl Rodrigo Neri-Bale
- Coronary Care Unit, National Institute of Cardiology “Ignacio Chávez”, Mexico City, Mexico.Coronary Care UnitNational Institute of Cardiology “Ignacio Chávez”Mexico CityMexico
| | - Lilia Hernández-Bravo
- Coronary Care Unit, National Institute of Cardiology “Ignacio Chávez”, Mexico City, Mexico.Coronary Care UnitNational Institute of Cardiology “Ignacio Chávez”Mexico CityMexico
| | - Manuel A. Candia-Ramírez
- Coronary Care Unit, National Institute of Cardiology “Ignacio Chávez”, Mexico City, Mexico.Coronary Care UnitNational Institute of Cardiology “Ignacio Chávez”Mexico CityMexico
| | - Rodrigo Gopar-Nieto
- Coronary Care Unit, National Institute of Cardiology “Ignacio Chávez”, Mexico City, Mexico.Coronary Care UnitNational Institute of Cardiology “Ignacio Chávez”Mexico CityMexico
| | - Héctor González-Pacheco
- Coronary Care Unit, National Institute of Cardiology “Ignacio Chávez”, Mexico City, Mexico.Coronary Care UnitNational Institute of Cardiology “Ignacio Chávez”Mexico CityMexico
| | - Jorge Daniel Sierra-Lara Martinez
- Coronary Care Unit, National Institute of Cardiology “Ignacio Chávez”, Mexico City, Mexico.Coronary Care UnitNational Institute of Cardiology “Ignacio Chávez”Mexico CityMexico
| | - Alexandra Arias-Mendoza
- Coronary Care Unit, National Institute of Cardiology “Ignacio Chávez”, Mexico City, Mexico.Coronary Care UnitNational Institute of Cardiology “Ignacio Chávez”Mexico CityMexico
| | - Diego Araiza-Garaygordobil
- Coronary Care Unit, National Institute of Cardiology “Ignacio Chávez”, Mexico City, Mexico.Coronary Care UnitNational Institute of Cardiology “Ignacio Chávez”Mexico CityMexico
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3
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Tsai T, Tsai M, Chen D, Lin Y, Peng J, Yang N, Hung M, Chen T. Evaluating the applicability of ivabradine in acute heart failure. Clin Cardiol 2024; 47:e24206. [PMID: 38269634 PMCID: PMC10765997 DOI: 10.1002/clc.24206] [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: 10/07/2023] [Revised: 11/06/2023] [Accepted: 12/04/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND While ivabradine has demonstrated benefits in heart rate control and prognosis for chronic heart failure patients, its application in acute decompensated heart failure remains underexplored. HYPOTHESIS For patients with acute decompensated heart failure with reduced ejection fraction (HFrEF) who are intolerant to β-blockers or unable to further titrate their dosage, the use of ivabradine is hypothesized to be effective and safe is improving outcomes. METHODS This retrospective, multicenter database analysis included patients with hospitalized decompensated heart failure with a left ventricular ejection fraction of ≤40% from June 1, 2015 to December 31, 2020. The exclusion criteria were a baseline heart rate of <70 bpm, previous use of ivabradine, mortality during admission, existing atrial fibrillation, or atrial flutter. The primary outcome was the composite of cardiovascular death and hospitalization for heart failure. RESULTS Of the 4163 HFrEF patients analyzed, 684 (16.4%) were administered ivabradine during their index admission. After matching, there were 617 patients in either group. The results indicated that ivabradine use was not significantly associated with the risk of the primary composite outcome (hazard ratio: 1.10; 95% confidence interval: 0.94-1.29). Similarly, the risk of secondary outcomes and adverse renal events did not significantly differ between the ivabradine and non-ivabradine cohorts (all p > .05). CONCLUSION For hospitalized acute decompensated heart failure patients who are intolerant to β-blockers or cannot further titrate them, ivabradine offers a consistent therapeutic effect. No significant disparities were noted between the ivabradine and non-ivabradine groups in heart failure hospitalization and cardiovascular death.
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Affiliation(s)
- Tzu‐Hsien Tsai
- Department of Internal Medicine, Division of CardiologyDitmanson Medical Foundation Chiayi Christian HospitalChiayiTaiwan
| | - Ming‐Lung Tsai
- Department of Internal Medicine, Division of CardiologyNew Taipei Municipal TuCheng HospitalNew TaipeiTaiwan
- College of MedicineChang Gung UniversityTaoyuanTaiwan
- College of ManagementChang Gung UniversityTaoyuanTaiwan
| | - Dong‐Yi Chen
- College of MedicineChang Gung UniversityTaoyuanTaiwan
- Department of Internal Medicine, Division of CardiologyLinkou Chang Gung Memorial HospitalTaoyuanTaiwan
| | - Yuan Lin
- College of MedicineChang Gung UniversityTaoyuanTaiwan
- Department of Emergency MedicineKeelung Chang Gung Memorial HospitalKeelungTaiwan
| | - Jian‐Rong Peng
- Department of Internal Medicine, Division of CardiologyNew Taipei Municipal TuCheng HospitalNew TaipeiTaiwan
- College of MedicineChang Gung UniversityTaoyuanTaiwan
| | - Ning‐I Yang
- College of MedicineChang Gung UniversityTaoyuanTaiwan
- Department of Internal Medicine, Division of CardiologyKeelung Chang Gung Memorial HospitalKeelungTaiwan
| | - Ming‐Jui Hung
- College of MedicineChang Gung UniversityTaoyuanTaiwan
- Department of Internal Medicine, Division of CardiologyKeelung Chang Gung Memorial HospitalKeelungTaiwan
| | - Tien‐Hsing Chen
- College of MedicineChang Gung UniversityTaoyuanTaiwan
- Department of Internal Medicine, Division of CardiologyKeelung Chang Gung Memorial HospitalKeelungTaiwan
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Yang TY, Tsai MS, Jan JY, Chang JJ, Chung CM, Lin MS, Chen HM, Lin YS. Early administration of ivabradine in patients admitted for acute decompensated heart failure. Front Cardiovasc Med 2022; 9:1036418. [PMID: 36523364 PMCID: PMC9744812 DOI: 10.3389/fcvm.2022.1036418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 11/09/2022] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Heart rate (HR) control is important in heart failure (HF) patients with reduced ejection fraction, and ivabradine is indicated for patients with chronic HF and sinus rhythm. However, ivabradine is limited in initiation of ivabradine at acute stage of HF. MATERIALS AND METHODS This multi-institutional retrospective study enrolled 30,639 patients who were admitted for HF from January 01, 2013 to December 31, 2018 at Chang Gung Memorial Hospitals. After applying selection criteria, the eligible patients were divided into ivabradine and non-ivabradine groups according to the initiation of ivabradine at the index hospitalization. HR, clinical outcomes including HF hospitalization, all-cause hospitalization, mortality, the composite of cardiovascular (CV) death or HF hospitalization and newly developed atrial fibrillation, and left ventricular ejection fraction (LVEF) and left atrium size were compared between the ivabradine and non-ivabradine groups after inverse probability of treatment weighting (IPTW) analysis after 12 months. RESULTS The HR at admission in the ivabradine group (n = 433) was 99.04 ± 20.69/min, compared to 86.99 ± 20.34/min in the non-ivabradine group (n = 9,601). After IPTW, HR was lower in the ivabradine group than that in the non-ivabradine group after 12 months (74.14 ± 8.53 vs. 81.23 ± 16.79 bpm, p = 0.079). However, there were no significant differences in HF hospitalization (HR = 1.02; 95% CI, 0.38-2.79), all-cause hospitalization (HR = 0.95; 95% CI, 0.54-1.68), mortality (HR = 0.87; 95% CI, 0.69-1.08), the composite of CV death or HF hospitalization (HR = 0.87; 95% CI, 0.69-1.08) and newly developed AF between the two groups. In addition, LVEF increased with time in both groups, but there were no significant differences during the observation period. CONCLUSION Ivabradine was beneficial in controlling HR when initiated in patients with acute stage of HF, but it did not seem to provide any benefits in reducing HF hospitalization, all-cause hospitalization, and mortality in 1 year after discharge.
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Affiliation(s)
- Teng-Yao Yang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Meng-shu Tsai
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Jeng-Yu Jan
- Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Jung-Jung Chang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chang-Ming Chung
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ming-Shyan Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Hui-Ming Chen
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Yu-Sheng Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
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Yanagiya R, Wanezaki M, Nakamura N, Ichikawa T, Hayasaka T, Yamada A, Aizawa K, Ito S, Himuro M, Suzuki H, Yamamoto M, Toubai T, Watanabe M, Ishizawa K. Ivabradine as an Adjuvant Agent for Severe Heart Failure Occurring in the Early Phase after Allogeneic Hematopoietic Cell Transplantation. Intern Med 2022; 61:2779-2784. [PMID: 35249914 PMCID: PMC9556237 DOI: 10.2169/internalmedicine.7946-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Cardiotoxicity is a critical complication of allogeneic hematopoietic cell transplantation (allo-HCT). In particular, management of severe cardiotoxicity occurring in the early phases of allo-HCT is challenging. We encountered a case of severe cardiotoxicity resulting from AHF six days after allo-HCT, which resisted catecholamines and diuretics. The patient was treated with anthracycline-containing regimens and underwent myeloablative conditioning, including high-dose cyclophosphamide. As invasive circulatory assisting devices were contraindicated because of his immunocompromised status and bleeding tendency, we successfully treated the patient with ivabradine-containing medications. Ivabradine may therefore be considered an alternative drug for the treatment of severe cardiotoxicity induced by cytotoxic agents.
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Affiliation(s)
- Ryo Yanagiya
- Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology (3rd Department of Internal Medicine), Faculty of Medicine, Yamagata University, Japan
| | - Masahiro Wanezaki
- 1st Department of Internal Medicine, Faculty of Medicine, Yamagata University, Japan
- Department of Critical Care Unit, Yamagata University Hospital, Japan
| | - Naohisa Nakamura
- Department of Critical Care Unit, Yamagata University Hospital, Japan
| | - Tsubasa Ichikawa
- Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology (3rd Department of Internal Medicine), Faculty of Medicine, Yamagata University, Japan
| | - Tatsuya Hayasaka
- Department of Critical Care Unit, Yamagata University Hospital, Japan
| | - Akane Yamada
- Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology (3rd Department of Internal Medicine), Faculty of Medicine, Yamagata University, Japan
| | - Keiko Aizawa
- Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology (3rd Department of Internal Medicine), Faculty of Medicine, Yamagata University, Japan
| | - Satoshi Ito
- Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology (3rd Department of Internal Medicine), Faculty of Medicine, Yamagata University, Japan
| | - Masahito Himuro
- Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology (3rd Department of Internal Medicine), Faculty of Medicine, Yamagata University, Japan
| | - Hiroto Suzuki
- Department of Critical Care Unit, Yamagata University Hospital, Japan
| | - Masakazu Yamamoto
- Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology (3rd Department of Internal Medicine), Faculty of Medicine, Yamagata University, Japan
| | - Tomomi Toubai
- Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology (3rd Department of Internal Medicine), Faculty of Medicine, Yamagata University, Japan
| | - Masafumi Watanabe
- 1st Department of Internal Medicine, Faculty of Medicine, Yamagata University, Japan
| | - Kenichi Ishizawa
- Department of Neurology, Hematology, Metabolism, Endocrinology and Diabetology (3rd Department of Internal Medicine), Faculty of Medicine, Yamagata University, Japan
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6
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Ando M, Watanabe N, Saku K, Morishima I. Acute-phase administration of ivabradine supported by intra-aortic balloon pump induces myocardial recovery without significant haemodynamic worsening in a patient with acute fulminant myocarditis: a case report. Eur Heart J Case Rep 2022; 6:ytac340. [PMID: 36032038 PMCID: PMC9411543 DOI: 10.1093/ehjcr/ytac340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/17/2022] [Accepted: 08/09/2022] [Indexed: 11/14/2022]
Abstract
Background Ivabradine can reduce the heart rate without affecting myocardial contractility or vascular tone. Current guidelines recommend its use for treating patients with chronic heart failure who have a high heart rate (≥75 b.p.m.) and persistent symptoms despite guideline-directed therapy. Nonetheless, little is known about its efficacy in patients with acute cardiogenic shock. We report a case of successful treatment of cardiogenic shock Case summary A 53-year-old previously healthy man was admitted due to cardiogenic shock with acute fulminant myocarditis. The patient was placed on intra-aortic balloon pump support and was given guideline-directed therapy including inotropic agents and furosemide. However, no improvement was seen in haemodynamics and the patient was in sinus tachycardia (116 b.p.m.). On Day 2, ivabradine therapy was initiated to reduce the myocardial workload and stabilize the haemodynamic parameters. As heart rate decreased, his symptoms improved and urine output increased without affecting the blood pressure. Subsequently, the patient recovered from cardiogenic shock. The intra-aortic balloon pumping was discontinued on Day 7, and the patient was discharged on Day 22. Discussion Ivabradine has the potential to induce rapid cardiac recovery and haemodynamic improvement in the acute phase of heart failure if supported by intra-aortic balloon pump.
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Affiliation(s)
- Moriyasu Ando
- Department of Cardiology, Ogaki Municipal Hospital , Ogaki , Japan
| | - Naoki Watanabe
- Department of Cardiology, Ogaki Municipal Hospital , Ogaki , Japan
| | - Keita Saku
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center , Osaka , Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital , Ogaki , Japan
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Affiliation(s)
- Sambasivarao Kotha
- Department of Chemistry Indian Institute of Technology Bombay Powai Mumbai 400 076 India
| | | | - Yellaiah Tangella
- Department of Chemistry Indian Institute of Technology Bombay Powai Mumbai 400 076 India
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Datta PK, Rewari V, Ramachandran R, Singh PM, Ray BR, Aravindan A, Seth S, Parakh N, Trikha A. Effectiveness of enteral ivabradine for heart rate control in septic shock: A randomised controlled trial. Anaesth Intensive Care 2021; 49:366-378. [PMID: 34407620 DOI: 10.1177/0310057x211009913] [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: 01/26/2023]
Abstract
Persistent tachycardia in patients with septic shock predicts poor outcome. This study sought to investigate the effect of the cardiac pacemaker current inhibitor ivabradine on heart rate and cardio-circulatory function in patients with septic shock. After informed consent, 60 patients with septic shock and persistent tachycardia (heart rate >95 /minute) were prospectively randomly assigned to receive either standard therapy for septic shock (group S) or standard therapy along with enteral ivabradine (group I) for the initial 96 hours after enrolment. Primary outcome was the difference in heart rate between the two groups during the first 96 hours. Secondary outcomes included the effect of ivabradine on haemodynamic, oxygenation, myocardial function and organ function parameters, incidence of adverse events and 30-day overall survival. Heart rate was lower in group I compared to group S (median difference in area under the curve -25.6 (95% confidence intervals -31.4 to -15.9) /minute; P <0.001). Vasopressor requirements, blood lactate levels, Sequential Organ Failure Assessment scores and E/e' ratio were lower in group I compared to group S. Stroke volume index and ejection fraction were higher in group I while cardiac index and oxygen delivery parameters were maintained similar to group S. There was no difference in 30-day mortality or in the incidence of serious adverse events. Enteral ivabradine is effective in reducing heart rate, and improving haemodynamic parameters and cardiac function in patients with septic shock and persistent tachycardia, without increasing the incidence of adverse events.
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Affiliation(s)
- Priyankar K Datta
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Vimi Rewari
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Rashmi Ramachandran
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Preet M Singh
- Department of Anesthesiology, Washington University in Saint Louis, Saint Louis, MO, USA
| | - Bikash R Ray
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Ajisha Aravindan
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Seth
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Neeraj Parakh
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anjan Trikha
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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9
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Lipase-Catalyzed Kinetic Resolution of Alcohols as Intermediates for the Synthesis of Heart Rate Reducing Agent Ivabradine. Catalysts 2021. [DOI: 10.3390/catal11010053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Ivabradine (Corlanor®), is a chiral benzocycloalkane currently employed and commercialized for the treatment of chronic stable angina pectoris and for the reduction in sinus tachycardia. The eutomer (S)-ivabradine is usually produced via chiral resolution of intermediates, by employing enantiopure auxiliary molecules or through preparative chiral HPLC separations. Recently, more sustainable biocatalytic approaches have been reported in literature for the preparation of the chiral amine precursor. In this work, we report on a novel biocatalyzed pathway, via a resolution study of a key alcohol intermediate used as a precursor of the chiral amine. After screening several enzymatic reaction conditions, employing different lipases and esterases both for the esterification and hydrolysis reactions, the best result was achieved with Pseudomonas cepacia Lipase and the final product was obtained in up to 96:4 enantiomeric ratio (e.r.) of an ivabradine alcohol precursor. This enantiomer was then efficiently converted into the desired amine in a facile three step synthetic sequence.
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10
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Lee WC, Fang HY. Ivabradine for the Treatment of Acute Mitral-Regurgitation-Related Decompensated Heart Failure. Cardiology 2019; 144:97-100. [PMID: 31533098 DOI: 10.1159/000502475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 08/01/2019] [Indexed: 11/19/2022]
Abstract
Ivabradine is used as a second-line medication for chronic heart failure (HF) but is still off-label for acute HF. We report the case of a 50-year-old man who experienced infectious endocarditis-related acute severe mitral regurgitation (MR) and acute decompensated HF and showed quick improvement of clinical symptoms after ivabradine use. An unstable hemodynamic status does not allow titration of a β-blocker dose, and a β-agonist might be needed to overcome a critical condition. Ivabradine appears to solve this issue and protect the myocardium owing to prolongation of the diastolic perfusion time. Ivabradine might be useful for the treatment of acute severe MR-related acute decompensated HF due to the improvement of diastolic function by decreasing the heart rate.
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Affiliation(s)
- Wei-Chieh Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, .,Division of Cardiology, Cardiac Care Unit, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, .,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan,
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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11
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Wu W, Zhang L, Zhao J, Guo Y, Liu J, Shi D, Yang J, Liu Y, Lai J, Shen Z. Early short-term ivabradine treatment in new-onset acute systolic heart failure and sinus tachycardia patients with inflammatory rheumatic disease. Exp Ther Med 2019; 18:305-311. [PMID: 31258666 PMCID: PMC6566021 DOI: 10.3892/etm.2019.7531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 04/05/2019] [Indexed: 11/06/2022] Open
Abstract
Acute heart failure (AHF) is a common complication of inflammatory rheumatic disease (IRD) and usually coexists with tachycardia. Ivabradine, a direct sinus node inhibitor, which was proven to have favorable effects in patients with chronic HF (CHF), has not been sufficiently evaluated in AHF patients regarding its efficacy and safety. The present study sought to explore the effectiveness of early short-term ivabradine treatment in new-onset AHF and concurrent sinus tachycardia in patients with IRD. A total of 12 consecutive patients with IRD, who had new-onset AHF and concurrent sinus tachycardia, were prescribed ivabradine and were retrospectively recruited. Standard medication therapy for AHF was also administered. The heart rate (HR), left ventricular ejection fraction (LVEF), biomarkers of HF and New York Heart Association (NYHA) classification score were compared prior to and after ivabradine treatment. After 48 h of treatment with ivabradine, the mean resting HR decreased from 118.0±13.8 to 83.3±7.3 bpm (P<0.001). Transthoracic echocardiography indicated a significant improvement in the LVEF on an average of 2 weeks after ivabradine prescription when compared with the baseline evaluation (51.2±8.4 vs. 38.0±9.0%; P<0.001). In addition, ivabradine treatment resulted in significantly decreased N-terminal proB-type natriuretic peptide (4,900±3,672 vs. 16,806±16,130 pg/ml; P=0.045) and improvement of the NYHA classification score (2.3±0.6 vs. 3.5±0.5; P<0.001) at 2 weeks when compared with the baseline. Overall, the results of the present study suggested that early use of ivabradine is safe in IRD patients with new-onset AHF and enhances the sinus rate reduction, which may improve heart function.
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Affiliation(s)
- Wei Wu
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing 100730, P.R. China
| | - Lixi Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing 100730, P.R. China
| | - Jiuliang Zhao
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing 100730, P.R. China
| | - Yuchao Guo
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Jinjing Liu
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing 100730, P.R. China
| | - Di Shi
- Department of Emergency, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, P.R. China
| | - Jing Yang
- Department of Emergency, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, P.R. China
| | - Yingxian Liu
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing 100730, P.R. China
| | - Jinzhi Lai
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing 100730, P.R. China
| | - Zhujun Shen
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing 100730, P.R. China
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12
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Iacovoni A, D'Elia E, Gori M, Oliva F, Lorini FL, Senni M. Treating Patients Following Hospitalisation for Acute Decompensated Heart Failure: An Insight into Reducing Early Rehospitalisations. Card Fail Rev 2019; 5:78-82. [PMID: 31179016 PMCID: PMC6545980 DOI: 10.15420/cfr.2018.46.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 04/19/2019] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF) is a pandemic syndrome characterised by raised morbidity and mortality. An acute HF event requiring hospitalisation is associated with a poor prognosis, in both the short and the long term. Moreover, early rehospitalisation after discharge negatively affects HF management and survival rates. Cardiovascular and non-cardiovascular conditions combine to increase rates of HF hospital readmission at 30 days. A tailored approach for HF pharmacotherapy while the patient is in hospital and immediately after discharge could be useful in reducing early adverse events that cause rehospitalisation and, consequently, prevent worsening HF and readmission during the vulnerable phase after discharge.
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Affiliation(s)
- Attilio Iacovoni
- Cardiovascular Department, ASST Papa Giovanni XXIII Bergamo, Italy
| | - Emilia D'Elia
- Cardiovascular Department, ASST Papa Giovanni XXIII Bergamo, Italy
| | - Mauro Gori
- Cardiovascular Department, ASST Papa Giovanni XXIII Bergamo, Italy
| | - Fabrizio Oliva
- Cardiovascular Department, ASST Grande Ospedale Metropolitano Niguarda Milan, Italy
| | | | - Michele Senni
- Cardiovascular Department, ASST Papa Giovanni XXIII Bergamo, Italy
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13
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Pascual Izco M, Ramírez-Carracedo R, Hernández Navarro I, Osorio Ruiz Á, Castejón Navarro B, Cuadrado Berrocal I, Largo Aramburu C, Alonso Salinas GL, Díez J, Saura Redondo M, Zamorano JL, Zaragoza C, Sanmartín M. Ivabradine in acute heart failure: Effects on heart rate and hemodynamic parameters in a randomized and controlled swine trial. Cardiol J 2018; 27:62-71. [PMID: 30155868 PMCID: PMC8086495 DOI: 10.5603/cj.a2018.0078] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 08/14/2018] [Accepted: 05/20/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Acute heart failure patients could benefit from heart rate reduction, as myocardial consumption and oxidative stress are related to tachycardia. Ivabradine could have a clinical role attenuating catecholamine-induced tachycardia. The aim of this study was to evaluate hemodynamic effects of ivabradine in a swine model of acute heart failure. METHODS Myocardial infarction was induced by 45 min left anterior descending artery balloon occlusion in 18 anesthetized pigs. An infusion of dobutamine and noradrenaline was maintained aiming to preserve adequate hemodynamic support, accompanied by fluid administration to obtain a pulmonary wedged pressure ≥ 18 mmHg. After reperfusion, rhythm and hemodynamic stabilization, the animals were randomized to 0.3 mg/kg ivabradine intravenously (n = 9) or placebo (n = 9). Hemodynamic parameters were observed over a 60 min period. RESULTS Ivabradine was associated with a significant reduction in heart rate (88.4 ± 12.0 bpm vs. 122.7 ± 17.3 bpm after 15 min of ivabradine/placebo infusion, p < 0.01) and an increase in stroke volume (68.8 ± 13.7 mL vs. 52.4 ± 11.5 mL after 15 min, p = 0.01). There were no significant differences in systemic or pulmonary arterial pressure, or significant changes in pulmonary capillary pressure. However, after 15 min, cardiac output was significantly reduced with ivabradine (-5.2% vs. +15.0% variation in ivabradine/placebo group, p = 0.03), and central venous pressure increased (+4.2% vs. -19.7% variation, p < 0.01). CONCLUSIONS Ivabradine reduces heart rate and increases stroke volume without modifying systemic or left filling pressures in a swine model of acute heart failure. However, an excessive heart rate reduction could lead to a decrease in cardiac output and an increase in right filling pressures. Future studies with specific heart rate targets are needed.
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Affiliation(s)
- Marina Pascual Izco
- Cardiology Department, Ramón y Cajal University Hospital (IRYCIS), University of Alcalá de Henares, Madrid, Spain
| | - Rafael Ramírez-Carracedo
- Cardiology Department, Cardiovascular Research Unit. Francisco de Vitoria University - Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | - Ignacio Hernández Navarro
- Cardiology Department, Cardiovascular Research Unit. Francisco de Vitoria University - Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | - Álvaro Osorio Ruiz
- Vascular Surgery Department, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | | | | | | | - Gonzalo Luis Alonso Salinas
- Cardiology Department, Ramón y Cajal University Hospital (IRYCIS), University of Alcalá de Henares, Madrid, Spain
- CIBERCV, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | - Javier Díez
- Cardiology Department, Cardiovascular Research Unit. Francisco de Vitoria University - Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | - Marta Saura Redondo
- Physiology Unit, Systems Biology Department, University of Alcalá de Henares, Madrid, Spain
| | - José Luis Zamorano
- Cardiology Department, Ramón y Cajal University Hospital (IRYCIS), University of Alcalá de Henares, Madrid, Spain
- CIBERCV, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | - Carlos Zaragoza
- Cardiology Department, Cardiovascular Research Unit. Francisco de Vitoria University - Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
- CIBERCV, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | - Marcelo Sanmartín
- Cardiology Department, Ramón y Cajal University Hospital (IRYCIS), University of Alcalá de Henares, Madrid, Spain.
- CIBERCV, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain.
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14
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Sathyamurthy I, Newale S. Ivabradine: Evidence and current role in cardiovascular diseases and other emerging indications. Indian Heart J 2018; 70 Suppl 3:S435-S441. [PMID: 30595304 PMCID: PMC6309574 DOI: 10.1016/j.ihj.2018.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/31/2018] [Accepted: 08/05/2018] [Indexed: 12/18/2022] Open
Abstract
Increased heart rate (HR) is associated with deleterious effects on several disease conditions. Chronic heart failure (CHF) is one of the cardiovascular diseases with recurrent hospitalization burden and an ongoing drain on health-care expenditure. Despite advancement in medicine, management of CHF remains a challenge to health-care providers. Ivabradine selectively and specifically inhibits the pacemaker I(f) ionic current which reduces the cardiac pacemaker activity. The main effect of ivabradine therapy is the substantial lowering of HR. It does not influence intracardiac conduction, contractility, or ventricular repolarization. As shown in numerous clinical studies, ivabradine improves clinical outcomes and quality of life and reduces the risk of death from heart failure (HF) or other cardiovascular causes. Recently updated HF guidelines recommend ivabradine as a class II indication for reduction of HF hospitalizations. Based on the principle of benefits of reduced HR, the ivabradine in patients with ischemic heart disease, sepsis, and multiple organ dysfunction syndrome has also been studied. It can also be a useful agent for HR reduction in patients with contraindications to use beta-blockers or those who cannot tolerate them. In this review, we provide an overview of efficacy and safety of ivabradine and its combination with currently recommended pharmacological therapy in different conditions.
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Affiliation(s)
- I Sathyamurthy
- Dept of Cardiology, Apollo Hospitals, Chennai, 600006, India.
| | - Sanket Newale
- Dr. Newale Health Centre, Navi Mumbai, 400614, India.
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15
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Oliva F, Sormani P, Contri R, Campana C, Carubelli V, Cirò A, Morandi F, Di Tano G, Mortara A, Senni M, Metra M, Ammirati E. Heart rate as a prognostic marker and therapeutic target in acute and chronic heart failure. Int J Cardiol 2018; 253:97-104. [DOI: 10.1016/j.ijcard.2017.09.191] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 06/12/2017] [Accepted: 09/22/2017] [Indexed: 12/28/2022]
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16
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Pascual Izco M, Castejón B, Piedras MJ, Zamorano JL, Sanmartín M, Zaragoza C. Efectos de la ivabradina en la frecuencia cardiaca y los parámetros hemodinámicos en un modelo porcino de shock cardiogénico. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.11.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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17
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Pascual Izco M, Castejón B, Piedras MJ, Zamorano JL, Sanmartín M, Zaragoza C. Effects of Ivabradine on Heart Rate and Hemodynamic Parameters in a Swine Model of Cardiogenic Shock. ACTA ACUST UNITED AC 2017; 70:1139-1141. [PMID: 28363707 DOI: 10.1016/j.rec.2017.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 12/05/2016] [Indexed: 10/19/2022]
Affiliation(s)
- Marina Pascual Izco
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal (IRYCIS)-Universidad de Alcalá de Henares, Madrid, Spain
| | - Borja Castejón
- Servicio de Cardiología, Unidad de Investigación del Hospital Ramón y Cajal (IRYCIS)-Universidad Francisco de Vitoria, Madrid, Spain
| | - María José Piedras
- Servicio de Cardiología, Unidad de Investigación del Hospital Ramón y Cajal (IRYCIS)-Universidad Francisco de Vitoria, Madrid, Spain
| | - José Luis Zamorano
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal (IRYCIS)-Universidad de Alcalá de Henares, Madrid, Spain
| | - Marcelo Sanmartín
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal (IRYCIS)-Universidad de Alcalá de Henares, Madrid, Spain.
| | - Carlos Zaragoza
- Servicio de Cardiología, Unidad de Investigación del Hospital Ramón y Cajal (IRYCIS)-Universidad Francisco de Vitoria, Madrid, Spain
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19
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Pedragosa-Moreau S, Le Flohic A, Thienpondt V, Lefoulon F, Petit AM, Ríos-Lombardía N, Morís F, González-Sabín J. Exploiting the Biocatalytic Toolbox for the Asymmetric Synthesis of the Heart-Rate Reducing Agent Ivabradine. Adv Synth Catal 2017. [DOI: 10.1002/adsc.201601222] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
| | | | | | - François Lefoulon
- Technologie Servier; Research and Biopharmacy Centre; 27 rue Eugène Vignat 45000 Orléans France
| | - Anne-Marie Petit
- Technologie Servier; Research and Biopharmacy Centre; 27 rue Eugène Vignat 45000 Orléans France
| | | | - Francisco Morís
- EntreChem, S.L.; Edificio Científico Tecnológico; Campus El Cristo 33006 Oviedo Spain
| | - Javier González-Sabín
- EntreChem, S.L.; Edificio Científico Tecnológico; Campus El Cristo 33006 Oviedo Spain
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20
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Díez J, Bayés-Genis A. What is on the horizon for improved treatments for acutely decompensated heart failure? Eur Heart J Suppl 2016. [DOI: 10.1093/eurheartj/suw043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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21
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Ekmekçi A, Keskin M, Güvenç TS, Uluganyan M, Karaca G, Hayıroğlu Mİ, Ağustos SŞ, Eren M. Usefulness of the thrombolysis in myocardial infarction risk index in acute heart failure: a pilot study. Am J Emerg Med 2016; 34:2351-2355. [PMID: 27614368 DOI: 10.1016/j.ajem.2016.08.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/21/2016] [Accepted: 08/23/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Risk stratification in acute heart failure (AHF) is vital for both physicians and paramedical personals. Thrombolysis in myocardial infarction (TIMI) risk index (TRI) and modified TRI (mTRI) are novel and simple predictive risk indices that have been examined in patients with acute coronary syndrome. OBJECTIVE In the current study, we evaluated the relationship among TRI, mTRI, and mortality in patients with AHF. METHODS A total of 293 patients with AHF were retrospectively analyzed. The patients were divided into 2 groups: group 1 consisted of patients who survived and group 2 consisted of patients who died during a follow-up period of 120 days. Multivariate hierarchical logistic regression analysis was performed to evaluate the relationship among TRI, mTRI, and mortality. RESULTS All causes of death occurred in 84 patients (28.6%). Thrombolysis in myocardial infarction risk index was significantly higher in patients who died during follow-up (20.2 ± 12.4 vs 14.8 ± 8.9). The new risk score showed good predictive value for 120-day mortality. Before laboratory analysis, in-multivariate hierarchical logistic regression analysis TRI remained as an independent risk factor for mortality (odds ratio, 2.56; P < .001). After the laboratory analysis, despite the fact that TRI has lost its predictive value, mTRI remained an independent risk factor for mortality (odds ratio, 2.08; P = .01). CONCLUSION The TRI is a simple and strong predictor of all-cause mortality in patients who were admitted with AHF. The current study reveals for the first time the strong predictive value of TRI in patients with AHF.
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Affiliation(s)
- Ahmet Ekmekçi
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
| | - Muhammed Keskin
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey.
| | - Tolga Sinan Güvenç
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
| | - Mahmut Uluganyan
- Department of Cardiology Istanbul, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Turkey
| | - Gürkan Karaca
- Department of Cardiology, Amasya University, Amasya, Turkey
| | - Mert İlker Hayıroğlu
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
| | - Semra Şimşek Ağustos
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Eren
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
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