Effect of ivabradine on left ventricular remodelling after reperfused myocardial infarction: A pilot study.
BACKGROUND
Heart rate is a major determinant of myocardial oxygen demand; in ST-segment elevation myocardial infarction (STEMI), patients treated with primary percutaneous intervention (PPCI), heart rate at discharge correlates with mortality. Ivabradine is a pure heart rate-reducing agent that has no effect on blood pressure and contractility, and can reverse left ventricular (LV) remodelling in patients with heart failure.


OBJECTIVE
To evaluate whether ivabradine, when added to current guideline-based therapy, improves LV remodelling in STEMI patients treated with PPCI.


METHODS
This paired-cohort study included 124 patients between June 2011 and July 2012. Ivabradine (5mg twice daily) was given promptly after PPCI, along with beta-blockers, to obtain a heart rate<60 beats per minute (ivabradine group). This group was matched with STEMI patients treated in line with current guidelines, including beta-blockers (bisoprolol), according to age, sex, infarct-related coronary artery, ischaemia time and infarct size determined by initial cardiac magnetic resonance imaging (CMR) (control group). Statistical analyses were performed according to an intention-to-continue treatment principle. CMR data at 3 months were available for 122 patients.


RESULTS
Heart rate was lower in the ivabradine group than in the control group during the initial CMR (P=0.02) and the follow-up CMR (P=0.006). At the follow-up CMR, there was a smaller increase in LV end-diastolic volume index in the ivabradine group than in the control group (P=0.04). LV end-systolic volume index remained unchanged in the ivabradine group, but increased in the control group (P=0.01). There was a significant improvement in LV ejection fraction in the ivabradine group compared with in the control group (P=0.04).


CONCLUSIONS
In successfully reperfused STEMI patients, ivabradine may improve LV remodelling when added to current guideline-based therapy.
Soins intensifs cardiologiques - plateau de cardiologie interventionnelle, hôpital Haut-Lévêque, Pessac, France; Institut de rythmologie et de modélisation cardiaque LIRYC, CHU/université de Bordeaux/Inserm U1045, Pessac, France. Electronic address: edouard.gerbaud@chu-bordeaux.fr.
Edouard
E
Gerbaud
Unité d'imagerie thoracique, CHU de Bordeaux, Pessac, France; Institut de rythmologie et de modélisation cardiaque LIRYC, CHU/université de Bordeaux/Inserm U1045, Pessac, France.
Michel
M
Montaudon
Soins intensifs cardiologiques - plateau de cardiologie interventionnelle, hôpital Haut-Lévêque, Pessac, France.
Warren
W
Chasseriaud
Institut de rythmologie et de modélisation cardiaque LIRYC, CHU/université de Bordeaux/Inserm U1045, Pessac, France.
Stephen
S
Gilbert
Unité d'imagerie thoracique, CHU de Bordeaux, Pessac, France; Institut de rythmologie et de modélisation cardiaque LIRYC, CHU/université de Bordeaux/Inserm U1045, Pessac, France.
Hubert
H
Cochet
Service de cardiologie, CHU de Bordeaux, Pessac, France.
Yann
Y
Pucheu
Service de cardiologie, CHU de Bordeaux, Pessac, France.
Alice
A
Horovitz
Service de cardiologie, CHU de Bordeaux, Pessac, France; Institut de rythmologie et de modélisation cardiaque LIRYC, CHU/université de Bordeaux/Inserm U1045, Pessac, France.
Jacques
J
Bonnet
Service de cardiologie, CHU de Bordeaux, Pessac, France; Institut de rythmologie et de modélisation cardiaque LIRYC, CHU/université de Bordeaux/Inserm U1045, Pessac, France.
Hervé
H
Douard
Soins intensifs cardiologiques - plateau de cardiologie interventionnelle, hôpital Haut-Lévêque, Pessac, France; Institut de rythmologie et de modélisation cardiaque LIRYC, CHU/université de Bordeaux/Inserm U1045, Pessac, France.
Pierre
P
Coste
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001552:Benzazepines / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005240:Feasibility Studies; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D000077550:Ivabradine; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D009206:Myocardium / Q000473:pathology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects*; D020257:Ventricular Remodeling / Q000187:drug effects*
D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D001552:Benzazepines; D000077550:Ivabradine
Imagerie par résonance magnétique nucléaire; Infarctus du myocarde; Ivabradine; Left ventricular remodelling; Magnetic resonance imaging; Myocardial infarction; Remodelage ventriculaire gauche