Effects of selective heart rate reduction with ivabradine on LV function and central hemodynamics in patients with chronic coronary syndrome. (June 2021)

• Record Type: Journal Article
• Authors: Hohneck, Anna Lena; Fries, Peter; Stroeder, Jonas; Schneider, Günther; Schirmer, Stephan Henrik; Reil, Jan-Christian; Böhm, Michael; Laufs, Ulrich; Custodis, Florian
• Is Part Of: IJC heart & vasculature. Volume 34(2021)
• Publication Date: 2021-06
• Subjects: Heart rate reduction -- Chronic coronary syndrome -- Hemodynamics -- Arterial stiffness; ACS acute coronary syndrome -- AD aortic distensibility -- bpm beats per minute -- CAD coronary artery disease -- CCS chronic coronary syndrome -- cf carotid-femoral -- CMR cardiac magnetic resonance -- CV cardiovascular -- EDV end-diastolic -- EF ejection fraction -- ESC European Society of Cardiology -- ESV end-systolic -- FMD flow mediated dilation -- HFpEF heart failure with preserved ejection fraction -- HFrEF heart failure with reduced ejection fraction -- HR heart rate -- HRR heart rate reduction -- LV left ventricular -- MRI magnetic resonance imaging -- PET peak ejection time -- PER peak ejection rate -- PFR peak filling rate -- PFT peak filling time -- PWV pulse wave velocity -- RHR resting heart rate -- SV stroke volume -- VTC volume-time curve; Cardiovascular system -- Diseases -- Periodicals; Cardiovascular system -- Pathophysiology -- Periodicals; 616.1005
• DOI: 10.1016/j.ijcha.2021.100757
• Languages: English
• ISSNs: 2352-9067

Abstract

Abstract: Objectives: We assessed left ventricular (LV) function and central hemodynamic effects in patients with a heart rate (HR) at rest of ≥70 beats per minute (bpm) and chronic coronary syndrome (CCS) after long-term treatment with ivabradine compared to placebo by cardiac magnetic resonance (CMR) imaging. Methods and results: In a randomized, double-blinded, prospective cross-over design, 23 patients (18 male, 5 female) were treated with ivabradine (7.5 mg bid) or placebo for 6 months. CMR imaging was performed at baseline and after 6 and 12 months to determine LV functional parameters. Mean resting HR on treatment with ivabradine was 58 ± 8.2 bpm and 70.2 ± 8.3 bpm during placebo (p < 0.0001).There was no difference in systolic LV ejection fraction (ivabradine 57.4 ± 11.2% vs placebo 53.0 ± 10.9%, p = 0.18), indexed end-diastolic (EDVi) or end-systolic volumes (ESVi). Indexed stroke volume (SVi) (ml/m 2 ) remained unchanged after treatment with ivabradine. Volume time curve parameters reflecting systolic LV function (peak ejection rate and time) were unaffected by ivabradine, while both peak filling rate (PFR) and PFR/EDV were significantly increased. Mean aortic velocity (cm/s) was significantly reduced during treatment with ivabradine (ivabradine 6.7 ± 2.7 vs placebo 9.0 ± 3.4, p = 0.01). Aortic flow parameters were correlated to parameters of vascular stiffness. The strongest correlation was revealed for mean aortic velocity with aortic distensibility (AD) (r = −0.86 [−0.90 to −0.85], p < 0.0001). Conclusion: Long-term reduction of HR with ivabradine in patients with CCS improved diastolic function and reduced mean aortic flow velocity.