Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy.
Cardiovasc Ther. 2018 Jun;36(3):e12323. doi: 10.1111/1755-5922.12323. Epub 2018 Mar 6.
Heart rate (HR) is an important prognostic factor in patients affected by chronic heart failure (CHF); ivabradine has been demonstrated to significantly reduce nonfatal myocardial infarction and hospitalization rate for acute heart failure and to improve left ventricular (LV) reverse remodeling, quality of life, exercise capacity, and arterial elastance (Ea) in these patients. We aimed at evaluating the short-term effects of ivabradine on ventricular-arterial coupling (VAC), aortic stiffness, and endothelial function in stable patients with CHF.
We evaluated 30 consecutive CHF patients (LVEF≤ 35%, NYHA class II) with sinus rhythm and HR ≥ 70 bpm on optimized pharmacological therapy. All of them underwent both transthoracic echocardiogram to assess aortic elastic properties (aortic distensibility, AD; aortic stiffness index, ASI; systolic aortic strain, SAS) and VAC, and peripheral arterial tonometry to measure endothelial function. Therapy with ivabradine 5 mg bid was added and each patient was evaluated with the same examinations after 4 months.
At the baseline, 73% of patients had impaired VAC and 63% endothelial dysfunction. After 4 months, there was a significant improvement in the VAC value (ΔVAC -0.10 ± 0.18, P = .021), mainly linked to Ea (ΔEa -0.40 ± 0.23 mm Hg/mL; P = .003). All the parameters of aortic elasticity underwent significant improvement (ΔAD 1.82 ± 1.43 cm² × dyn ¹, P = .004; ΔASI -4.73 ± 6.07, P = .033; ΔSAS -7.98 ± 4.37%, P = .003). Lastly, we also noted a significant improvement of endothelial function (Δ RHI 0.35 ± 0.35; P < .001). At follow-up 40% of patients had impaired VAC (P = .018) and 33% endothelial dysfunction (P = .038).
In patients with CHF adding ivabradine on top to the standard optimized medical therapy, when indicated, seems to improve endothelial function, aortic properties, and VAC.
心率（HR）是慢性心力衰竭（CHF）患者的重要预后因素；已有研究表明，伊伐布雷定可显著降低非致死性心肌梗死和因急性心力衰竭住院的发生率，并改善这些患者的左心室（LV）逆向重构、生活质量、运动能力和动脉弹性（Ea）。我们旨在评估伊伐布雷定对稳定型 CHF 患者心室-动脉偶联（VAC）、主动脉僵硬度和内皮功能的短期影响。
我们评估了 30 例连续的 CHF 患者（LVEF≤35%，NYHA 心功能 II 级），这些患者在优化药物治疗的基础上窦性心律和 HR≥70bpm。所有患者均接受经胸超声心动图评估主动脉弹性特性（主动脉可扩张性、AD；主动脉僵硬度指数、ASI；收缩期主动脉应变、SAS）和 VAC，并进行外周动脉张力测量以评估内皮功能。在 4 个月后，给予伊伐布雷定 5mg bid 治疗，并对每位患者进行相同的检查。
基线时，73%的患者存在 VAC 受损，63%的患者存在内皮功能障碍。4 个月后，VAC 值显著改善（ΔVAC -0.10±0.18，P=0.021），主要与 Ea 相关（ΔEa -0.40±0.23mmHg/mL；P=0.003）。主动脉弹性的所有参数均显著改善（ΔAD 1.82±1.43cm²×dyn¹，P=0.004；ΔASI -4.73±6.07，P=0.033；ΔSAS -7.98±4.37%，P=0.003）。最后，我们还注意到内皮功能显著改善（ΔRHI 0.35±0.35；P<0.001）。随访时，40%的患者存在 VAC 受损（P=0.018），33%的患者存在内皮功能障碍（P=0.038）。
在 CHF 患者中，在标准优化药物治疗的基础上，如果需要，加用伊伐布雷定似乎可以改善内皮功能、主动脉特性和 VAC。
