Effect of ivabradine on left ventricular remodelling after reperfused myocardial infarction: A pilot study.

Abstract

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.

AIMS:

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.

• Authors: Edouard Gerbaud, Michel Montaudon, Warren Chasseriaud, Stephen Gilbert, Hubert Cochet, Yann Pucheu, Alice Horovitz, Jacques Bonnet, Hervé Douard, Pierre Coste
• Journal: Archives of cardiovascular diseases (Arch Cardiovasc Dis) Vol. 107 Issue 1 Pg. 33-41 (Jan 2014) ISSN: 1875-2128 [Electronic] Netherlands
• PMID: 24440004 (Publication Type: Journal Article, Observational Study)
• Copyright: Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Chemical References

• Adrenergic beta-Antagonists
• Anti-Arrhythmia Agents
• Benzazepines
• Ivabradine

Topics

• Adrenergic beta-Antagonists (therapeutic use)
• Aged
• Anti-Arrhythmia Agents (therapeutic use)
• Benzazepines (therapeutic use)
• Drug Therapy, Combination
• Feasibility Studies
• Female
• Heart Rate (drug effects)
• Humans
• Ivabradine
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Myocardial Infarction (diagnosis, physiopathology, therapy)
• Myocardium (pathology)
• Percutaneous Coronary Intervention (adverse effects)
• Pilot Projects
• Practice Guidelines as Topic
• Time Factors
• Treatment Outcome
• Ventricular Function, Left (drug effects)
• Ventricular Remodeling (drug effects)