Ozturk Serkan, Öztürk Selçuk, Erdem Fatma Hizal, Erdem Alim, Ayhan Selim, Dönmez İbrahim, Yazıcı Mehmet
Faculty of Medicine, Department of Cardiology, Abant Izzet Baysal University, Golkoy, Bolu, 14280, Turkey.
J Interv Card Electrophysiol. 2016 Sep;46(3):253-8. doi: 10.1007/s10840-016-0129-2. Epub 2016 Apr 2.
Heart rate (HR) reduction with ivabradine improves left ventricle filling by the prolongation of the diastolic time and increases stroke volume. But, it remains unclear what ivabradine's effect is on atrial conduction time and atrial mechanical functions. The aim of our study was to evaluate in stable outpatients with systolic heart failure (HF) the 3 months effect of ivabradine on atrial conduction time and mechanical functions.
We evaluated prospectively 43 (31 males, 12 females) patients with HF. Before and after treatment, all patients were evaluated by transthoracic M mode, two dimensional (2D), pulsed-wave (PW), continuous wave (CW), color flow and tissue Doppler imaging (TDI), and LA volumes were obtained apical four-chamber views by a disc's method. LA maximum volume (Vmax) at the end-systolic phase, LA minimum volume (Vmin) at the end-diastolic phase, and LA volume before atrial systole (Vp) were evaluated. The LA function parameters were calculated as follows: LA passive emptying volume = Vmax - Vp; LA passive emptying fraction = [(Vmax - Vp)/Vmax] × 100%, LA active emptying volume = Vp - Vmin; LA active emptying fraction = [(Vp - Vmin)/Vp] × 100%.
Thirty men and 13 women with mean ± SD age of 63.9 ± 10.1 years were included in this study. Resting heart rate was significantly reduced after ivabradine treatment. There were no significantly difference in LVEF, and E/A before and after ivabradine treatment. LA diameter and Vmin were similar before and after ivabradine treatment (p = 0.793 and p = 0.284). However, Vmax and Vp were significantly decreased after ivabradine treatment (p = 0.040 and p = 0.012). Moreover, LA active emptying volume and LA active emptying fraction were significantly decreased after ivabradine treatment (p = 0.030 and p = 0.008). The PA lateral, septal, and tricuspid durations were significantly reduced after ivabradine treatment (p < 0.001, p < 0.001, and p = 0.002, respectively). Interatrial electromechanical delay and right intra-atrial electromechanical delay were significantly decreased after ivabradine treatment (33.7 ± 12.7 vs 26.2 ± 10.1, p = 0.001; and 14.1 ± 6.1 vs 9.2 ± 6.8, p < 0.001).
The present study demonstrated that adding ivabradine to the standard therapy reduced HR and improves significantly LA electrical and mechanical functions in systolic HF patients.
伊伐布雷定降低心率可通过延长舒张期来改善左心室充盈，并增加每搏输出量。但是，伊伐布雷定对心房传导时间和心房机械功能的影响尚不清楚。我们研究的目的是评估伊伐布雷定对稳定的收缩性心力衰竭（HF）门诊患者心房传导时间和机械功能的3个月影响。
我们前瞻性地评估了43例（31例男性，12例女性）HF患者。治疗前后，所有患者均通过经胸M型、二维（2D）、脉冲波（PW）、连续波（CW）、彩色血流和组织多普勒成像（TDI）进行评估，并通过圆盘法从心尖四腔视图获取左心房容积。评估收缩期末期左心房最大容积（Vmax）、舒张期末期左心房最小容积（Vmin）和心房收缩前左心房容积（Vp）。左心房功能参数计算如下：左心房被动排空容积 = Vmax - Vp；左心房被动排空分数 = [(Vmax - Vp)/Vmax]×100%，左心房主动排空容积 = Vp - Vmin；左心房主动排空分数 = [(Vp - Vmin)/Vp]×100%。
本研究纳入了30例男性和13例女性，平均年龄±标准差为63.9±10.1岁。伊伐布雷定治疗后静息心率显著降低。伊伐布雷定治疗前后左心室射血分数（LVEF）和E/A无显著差异。伊伐布雷定治疗前后左心房直径和Vmin相似（p = 0.793和p = 0.284）。然而，伊伐布雷定治疗后Vmax和Vp显著降低（p = 0.040和p = 0.012）。此外，伊伐布雷定治疗后左心房主动排空容积和左心房主动排空分数显著降低（p = 0.030和p = 0.008）。伊伐布雷定治疗后肺动脉外侧、间隔和三尖瓣持续时间显著缩短（分别为p < 0.001、p < 0.001和p = 0.002）。伊伐布雷定治疗后房间机电延迟和右心房内机电延迟显著缩短（33.7±12.7 vs 26.2±10.1，p = 0.001；14.1±6.1 vs 9.2±6.8，p < 0.001）。
本研究表明，在标准治疗中加用伊伐布雷定可降低收缩性HF患者的心率，并显著改善左心房电和机械功能。
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