Kaski Juan Carlos, Gloekler Steffen, Ferrari Roberto, Fox Kim, Lévy Bernard I, Komajda Michel, Vardas Panos, Camici Paolo G
Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK.
Department of Cardiology, Schwarzwald-Baar Klinikum, Villingen-Schwenningen, Germany.
Open Heart. 2018 Mar 9;5(1):e000725. doi: 10.1136/openhrt-2017-000725. eCollection 2018.
In chronic stable angina, elevated heart rate contributes to the development of symptoms and signs of myocardial ischaemia by increasing myocardial oxygen demand and reducing diastolic perfusion time. Accordingly, heart rate reduction is a well-known strategy for improving both symptoms of myocardial ischaemia and quality of life (QOL). The heart rate-reducing agent ivabradine, a direct and selective inhibitor of the current, decreases myocardial oxygen consumption while increasing diastolic time, without affecting myocardial contractility or coronary vasomotor tone. Ivabradine is indicated for treatment of stable angina and chronic heart failure (HF). This review examines available evidence regarding the efficacy and safety of ivabradine in stable angina, when used as monotherapy or in combination with beta-blockers, in particular angina subgroups and in patients with stable angina with left ventricular systolic dysfunction (LVSD) or HF. Trials involving more than 45 000 patients receiving treatment with ivabradine have shown that this agent has antianginal and anti-ischaemic effects, regardless of age, sex, severity of angina, revascularisation status or comorbidities. This heart rate-lowering agent might also improve prognosis, reduce hospitalisation rates and improve QOL in angina patients with chronic HF and LVSD.
在慢性稳定型心绞痛中，心率升高通过增加心肌需氧量和缩短舒张期灌注时间，促使心肌缺血症状和体征的出现。因此，降低心率是改善心肌缺血症状和生活质量（QOL）的一项众所周知的策略。降心率药物伊伐布雷定是一种直接且选择性的 电流抑制剂，可降低心肌耗氧量，同时增加舒张期时间，而不影响心肌收缩力或冠状动脉血管舒缩张力。伊伐布雷定适用于治疗稳定型心绞痛和慢性心力衰竭（HF）。本综述探讨了有关伊伐布雷定在稳定型心绞痛中作为单一疗法或与β受体阻滞剂联合使用时的疗效和安全性的现有证据，特别是在心绞痛亚组以及伴有左心室收缩功能障碍（LVSD）或HF的稳定型心绞痛患者中的证据。涉及超过45000例接受伊伐布雷定治疗患者的试验表明，无论年龄、性别、心绞痛严重程度、血运重建状态或合并症如何，该药物均具有抗心绞痛和抗缺血作用。这种降心率药物还可能改善预后，降低住院率，并改善慢性HF和LVSD心绞痛患者的生活质量。
