Cardiovascular Disease Unit, San Martino Policlinic Hospital, Genoa, Italy.
Department of Internal Medicine, University of Genoa, Genoa, Italy.
Chemotherapy. 2018;63(6):315-320. doi: 10.1159/000495576. Epub 2019 Mar 6.
Patients developing cancer treatment-related left ventricular dysfunction (CTrLVD) require a prompt therapy. Hypotension, dizziness, and fatigue often limit the use of angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), and β-blockers (BB) in cancer patients who may already be afflicted by these symptoms. Ivabradine is a heart rate-lowering drug that does not cause hypotension and may be used in heart failure with reduced left ventricular ejection fraction (LVEF).
The aim of this paper was to investigate the role of ivabradine to treat CTrLVD.
A retrospective analysis in a cohort of 30 patients with CTrLVD (LVEF < 50%) receiving ivabradine on top of the maximal tolerated dose of ACEi/ARB and BB was performed. We evaluated cardiovascular treatment, oncologic treatment, LVEF, functional class (New York Heart Association [NYHA]), and fatigue during the study period.
Ivabradine was initially started at the dose of 2.5 mg/b.i.d. in most patients and then carefully titrated. Hypotension (70%) and fatigue (77%) were the main causes limiting the treatment with ACEi/ARB and BB. After a mean follow-up of 6.5 months, LVEF increased from 45.1% (SD = 6.4) to 53.2% (SD = 3.9; p < 0.001). When patients were analyzed according to the type of cancer therapy, no difference in LVEF changes across the groups was found. NYHA class ameliorated in 11 patients, while fatigue improved in 8 patients. No serious cardiovascular side effects were reported.
The ability to improve symptoms and LVEF in unfit cancer patients makes ivabradine a reasonable pharmacological tool for treating CTrLVD.
发生癌症治疗相关左心室功能障碍（CTrLVD）的患者需要及时治疗。低血压、头晕和疲劳常限制血管紧张素转换酶抑制剂（ACEi）、血管紧张素受体阻滞剂（ARB）和β受体阻滞剂（BB）在可能已经有这些症状的癌症患者中的应用。伊伐布雷定是一种降低心率的药物，不会导致低血压，可用于射血分数降低的心力衰竭（LVEF）。
本文旨在探讨伊伐布雷定治疗 CTrLVD 的作用。
对 30 例 CTrLVD（LVEF < 50%）患者进行回顾性队列分析，这些患者在接受最大耐受剂量 ACEi/ARB 和 BB 的基础上加用伊伐布雷定。我们评估了研究期间的心血管治疗、肿瘤治疗、LVEF、心功能分级（纽约心脏协会 [NYHA]）和疲劳情况。
大多数患者最初以 2.5mg 每天两次的剂量开始使用伊伐布雷定，然后仔细滴定。低血压（70%）和疲劳（77%）是限制 ACEi/ARB 和 BB 治疗的主要原因。平均随访 6.5 个月后，LVEF 从 45.1%（SD=6.4）增加到 53.2%（SD=3.9；p<0.001）。当根据癌症治疗类型对患者进行分析时，各组之间的 LVEF 变化没有差异。NYHA 心功能分级改善 11 例，疲劳改善 8 例。未报告严重的心血管副作用。
伊伐布雷定能够改善不适宜患者的症状和 LVEF，使其成为治疗 CTrLVD 的合理药物工具。
