Gerbaud Edouard, Montaudon Michel, Chasseriaud Warren, Gilbert Stephen, Cochet Hubert, Pucheu Yann, Horovitz Alice, Bonnet Jacques, Douard Hervé, Coste Pierre
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.
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.
Arch Cardiovasc Dis. 2014 Jan;107(1):33-41. doi: 10.1016/j.acvd.2013.12.001. Epub 2014 Jan 14.
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.
To evaluate whether ivabradine, when added to current guideline-based therapy, improves LV remodelling in STEMI patients treated with PPCI.
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.
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).
In successfully reperfused STEMI patients, ivabradine may improve LV remodelling when added to current guideline-based therapy.
心率是心肌需氧量的主要决定因素；在ST段抬高型心肌梗死（STEMI）患者中，接受直接经皮冠状动脉介入治疗（PPCI）的患者出院时的心率与死亡率相关。伊伐布雷定是一种单纯降低心率的药物，对血压和心肌收缩力无影响，并且可以逆转心力衰竭患者的左心室（LV）重构。
评估在基于当前指南的治疗基础上加用伊伐布雷定是否能改善接受PPCI治疗的STEMI患者的左心室重构。
这项配对队列研究纳入了2011年6月至2012年7月期间的124例患者。PPCI后立即给予伊伐布雷定（每日两次，每次5mg），同时给予β受体阻滞剂，以使心率<60次/分钟（伊伐布雷定组）。根据年龄、性别、梗死相关冠状动脉、缺血时间和通过初始心脏磁共振成像（CMR）确定的梗死面积，将该组与按照当前指南治疗的STEMI患者（包括比索洛尔）进行匹配（对照组）。根据意向性继续治疗原则进行统计分析。122例患者可获得3个月时的CMR数据。
在初始CMR期间（P=0.02）和随访CMR期间（P=0.006），伊伐布雷定组的心率低于对照组。在随访CMR时，伊伐布雷定组左心室舒张末期容积指数的增加幅度小于对照组（P=0.04）。伊伐布雷定组左心室收缩末期容积指数保持不变，而对照组增加（P=0.01）。与对照组相比，伊伐布雷定组的左心室射血分数有显著改善（P=0.04）。
在成功再灌注的STEMI患者中，在基于当前指南的治疗基础上加用伊伐布雷定可能改善左心室重构。
