Favourable effects of heart rate reduction with intravenous administration of ivabradine in patients with advanced heart failure.
BACKGROUND
Heart rate (HR) reduction may be useful in treatment of patients with heart failure (HF). There are no data on the haemodynamic effects of ivabradine (a selective I(f) current inhibitor) in advanced HF patients.


OBJECTIVE
To assess the haemodynamic effects of ivabradine in patients with advanced HF and markedly depressed left ventricular (LV) function.


RESULTS
Ten NYHA class III patients (50+/-12 years, LV ejection fraction 21+/-7%) underwent 24-h haemodynamic monitoring. Ivabradine 0.1 mg/kg was infused over 90', followed by 0.05-0.075 mg/kg in the subsequent 90'. Baseline HR was 93+/-8 bpm, cardiac index (CI) 2.2+/-0.6 l/min*m2; LV stroke volume 44+/-11 ml and systolic work 39+/-13 g. Ivabradine significantly reduced HR, by a maximum of 27% (to 68+/-9 bpm) at 4 h, without decreasing CI. Ivabradine increased stroke volume and LV systolic work by a maximum of 51% (to 66+/-17 ml) and 53% (to 58+/-20 g) at 4 h. No serious adverse events occurred.


CONCLUSIONS
In patients with advanced HF and markedly depressed LV function, the acute administration of ivabradine is well tolerated, effectively reduces HR, markedly increases stroke volume and preserves cardiac output. Ivabradine appears a promising approach for the treatment of patients with moderate and advanced heart failure.
De Ferrari
Gaetano M
GM
Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. g.deferrari@smatteo.pv.it <g.deferrari@smatteo.pv.it>
Mazzuero
Antonio
A
Agnesina
Laura
L
Bertoletti
Alessandra
A
Lettino
Maddalena
M
Campana
Carlo
C
Schwartz
Peter J
PJ
Tavazzi
Luigi
L
D000328:Adult; D001552:Benzazepines / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D007262:Infusions, Intravenous; D000077550:Ivabradine; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D013318:Stroke Volume; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology*
D001552:Benzazepines; D000077550:Ivabradine