title: Effects of selective heart rate reduction with ivabradine on left ventricular remodelling and function: results from the SHIFT echocardiography substudy.
abstract: OBJECTIVE
  The SHIFT echocardiographic substudy evaluated the effects of ivabradine on left ventricular (LV) remodelling in heart failure (HF).
  
  
  RESULTS
  Eligible patients had chronic HF and systolic dysfunction [LV ejection fraction (LVEF) ≤35%], were in sinus rhythm, and had resting heart rate ≥70 bpm. Patients were randomly allocated to ivabradine or placebo, superimposed on background therapy for HF. Complete echocardiographic data at baseline and 8 months were available for 411 patients (ivabradine 208, placebo 203). Treatment with ivabradine reduced LVESVI (primary substudy endpoint) vs. placebo [-7.0 ± 16.3 vs. -0.9 ± 17.1 mL/m(2); difference (SE), -5.8 (1.6), 95% CI -8.8 to -2.7, P< 0.001]. The reduction in LVESVI was independent of beta-blocker use, HF aetiology, and baseline LVEF. Ivabradine also improved LV end-diastolic volume index (-7.9 ± 18.9 vs. -1.8 ± 19.0 mL/m(2), P= 0.002) and LVEF (+2.4 ± 7.7 vs. -0.1 ± 8.0%, P< 0.001). The incidence of the SHIFT primary composite outcome (cardiovascular mortality or hospitalization for worsening HF) was higher in patients with LVESVI above the median (59 mL/m2) at baseline (HR 1.62, 95% CI 1.03-2.56, P= 0.04). Patients with the largest relative reductions in LVESVI had the lowest event rates.
  
  
  CONCLUSIONS
  Ivabradine reverses cardiac remodelling in patients with HF and LV systolic dysfunction.
authors.affiliation: Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, Quebec, Canada H1T 1C8. jean-claude.tardif@icm-mhi.org
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Tardif
authors.forename: Eileen
authors.initials: E
authors.lastname: O'Meara
authors.forename: Michel
authors.initials: M
authors.lastname: Komajda
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Borer
authors.forename: Ian
authors.initials: I
authors.lastname: Ford
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
authors.forename: Karl
authors.initials: K
authors.lastname: Swedberg
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D001552:Benzazepines / Q000627:therapeutic use*; D004311:Double-Blind Method; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D000077550:Ivabradine; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy*; D020257:Ventricular Remodeling / Q000187:drug effects*
chemical_list: D000889:Anti-Arrhythmia Agents; D001552:Benzazepines; D000077550:Ivabradine