伊伐布雷定治疗可预防急性失代偿性心力衰竭患者多巴酚丁胺诱导的心率增加。
Ivabradine treatment prevents dobutamine-induced increase in heart rate in patients with acute decompensated heart failure.
作者信息
Cavusoglu Yuksel, Mert Ugur, Nadir Aydin, Mutlu Fezan, Morrad Bektas, Ulus Taner
机构信息
aCardiology Department bBiostatistic Department, Eskisehir Osmangazi University, Eskisehir, Turkey.
出版信息
J Cardiovasc Med (Hagerstown). 2015 Sep;16(9):603-9. doi: 10.2459/JCM.0000000000000033.
BACKGROUND
Ivabradine is a heart rate (HR)-lowering agent acting by inhibiting the If-channel. Dobutamine does increase the HR and has some deleterious effects on myocardium. So, we aimed to evaluate whether ivabradine treatment blunts a dobutamine-induced increase in HR.
METHODS
The main study population consisted of 58 acute decompensated heart failure patients requiring inotropic support with left-ventricular ejection fraction below 35%, who were randomized to ivabradine (n = 29) or control (n = 29). All patients underwent Holter recording for 6 h and then dobutamine was administered at incremental doses of 5, 10 and 15 μg/kg/min, with 6-h steps. Holter recording was continued during dobutamine infusion. Ivabradine 7.5 mg was given at the initiation of dobutamine and readministered at 12 h of infusion. Also, a nonrandomized beta-blocker group with 15 patients receiving beta-blocker was included in the analysis. Control and beta-blocker groups did not receive ivabradine.
RESULTS
In the control group, mean HR gradually and significantly increased at each step of dobutamine infusion (81 ± 11, 90 ± 16, 97 ± 14 and 101 ± 16 b.p.m., respectively; P = 0.001), whereas no significant increase in HR was observed in the ivabradine group (82 ± 17, 82 ± 15, 85 ± 14 and 83 ± 12 b.p.m., respectively; P = 0.439). Mean HR was also found to significantly increase during dobutamine infusion in the beta-blocker group (75 ± 13, 82 ± 13, 86 ± 14 and 88 ± 13 b.p.m., respectively; P = 0.001). The median increase in HR from baseline was significantly higher in the control group compared to those in the ivabradine group (5 vs. 2 b.p.m.; P = 0.007 at first step, 13 vs. 5 b.p.m.; P = 0.001 at second step and 18 vs. 6 b.p.m.; P = 0.0001 at third step of dobutamine, respectively).
CONCLUSIONS
Ivabradine treatment prevents dobutamine-induced increase in HR and may be useful in reducing HR-related adverse effects of dobutamine.
背景
伊伐布雷定是一种通过抑制If通道来降低心率（HR）的药物。多巴酚丁胺会增加心率，并且对心肌有一些有害影响。因此，我们旨在评估伊伐布雷定治疗是否能减弱多巴酚丁胺引起的心率增加。
方法
主要研究人群包括58例急性失代偿性心力衰竭患者，这些患者需要使用正性肌力药物支持，左心室射血分数低于35%，他们被随机分为伊伐布雷定组（n = 29）或对照组（n = 29）。所有患者均进行6小时的动态心电图记录，然后以5、10和15μg/kg/min的递增剂量静脉输注多巴酚丁胺，每步持续6小时。在多巴酚丁胺输注期间持续进行动态心电图记录。在多巴酚丁胺输注开始时给予伊伐布雷定7.5mg，并在输注12小时时再次给药。此外，分析中纳入了一个非随机的β受体阻滞剂组，其中15例患者接受β受体阻滞剂治疗。对照组和β受体阻滞剂组未接受伊伐布雷定治疗。
结果
在对照组中，多巴酚丁胺输注的每个阶段平均心率均逐渐且显著增加（分别为81±11、90±16、97±14和101±16次/分钟；P = 0.001），而伊伐布雷定组未观察到心率显著增加（分别为82±17、82±15、85±14和83±12次/分钟；P = 0.439）。在β受体阻滞剂组中，多巴酚丁胺输注期间平均心率也显著增加（分别为75±13、82±13、86±14和88±13次/分钟；P = 0.001）。与伊伐布雷定组相比，对照组心率从基线的中位数增加显著更高（第一步时为5次/分钟对2次/分钟；P = 0.007，第二步时为13次/分钟对5次/分钟；P = 0.001，多巴酚丁胺第三步时为18次/分钟对6次/分钟；P = 0.0001）。
结论
伊伐布雷定治疗可预防多巴酚丁胺引起的心率增加，可能有助于减少多巴酚丁胺与心率相关的不良反应。
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