Wu Wei, Zhang Lixi, Zhao Jiuliang, Guo Yuchao, Liu Jinjing, Shi Di, Yang Jing, Liu Yingxian, Lai Jinzhi, Shen Zhujun
Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing 100730, P.R. China.
Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing 100730, P.R. China.
Exp Ther Med. 2019 Jul;18(1):305-311. doi: 10.3892/etm.2019.7531. Epub 2019 Apr 25.
Acute heart failure (AHF) is a common complication of inflammatory rheumatic disease (IRD) and usually coexists with tachycardia. Ivabradine, a direct sinus node inhibitor, which was proven to have favorable effects in patients with chronic HF (CHF), has not been sufficiently evaluated in AHF patients regarding its efficacy and safety. The present study sought to explore the effectiveness of early short-term ivabradine treatment in new-onset AHF and concurrent sinus tachycardia in patients with IRD. A total of 12 consecutive patients with IRD, who had new-onset AHF and concurrent sinus tachycardia, were prescribed ivabradine and were retrospectively recruited. Standard medication therapy for AHF was also administered. The heart rate (HR), left ventricular ejection fraction (LVEF), biomarkers of HF and New York Heart Association (NYHA) classification score were compared prior to and after ivabradine treatment. After 48 h of treatment with ivabradine, the mean resting HR decreased from 118.0±13.8 to 83.3±7.3 bpm (P<0.001). Transthoracic echocardiography indicated a significant improvement in the LVEF on an average of 2 weeks after ivabradine prescription when compared with the baseline evaluation (51.2±8.4 vs. 38.0±9.0%; P<0.001). In addition, ivabradine treatment resulted in significantly decreased N-terminal proB-type natriuretic peptide (4,900±3,672 vs. 16,806±16,130 pg/ml; P=0.045) and improvement of the NYHA classification score (2.3±0.6 vs. 3.5±0.5; P<0.001) at 2 weeks when compared with the baseline. Overall, the results of the present study suggested that early use of ivabradine is safe in IRD patients with new-onset AHF and enhances the sinus rate reduction, which may improve heart function.
急性心力衰竭（AHF）是炎性风湿性疾病（IRD）的常见并发症，通常与心动过速并存。伊伐布雷定是一种直接的窦房结抑制剂，已被证明对慢性心力衰竭（CHF）患者有良好效果，但在AHF患者中的疗效和安全性尚未得到充分评估。本研究旨在探讨早期短期伊伐布雷定治疗对IRD患者新发AHF及并发窦性心动过速的有效性。连续纳入12例新发AHF并并发窦性心动过速的IRD患者，给予伊伐布雷定治疗，并进行回顾性研究。同时给予AHF标准药物治疗。比较伊伐布雷定治疗前后的心率（HR）、左心室射血分数（LVEF）、心力衰竭生物标志物及纽约心脏协会（NYHA）分级评分。伊伐布雷定治疗48小时后，平均静息心率从118.0±13.8次/分钟降至83.3±7.3次/分钟（P<0.001）。经胸超声心动图显示，与基线评估相比，伊伐布雷定用药后平均2周时LVEF有显著改善（51.2±8.4%对38.0±9.0%；P<0.001）。此外，与基线相比，伊伐布雷定治疗2周时N末端B型利钠肽原显著降低（4900±3672对16806±16130 pg/ml；P=0.045），NYHA分级评分改善（2.3±0.6对3.5±0.5；P<0.001）。总体而言，本研究结果表明，早期使用伊伐布雷定对新发AHF的IRD患者是安全的，可增强窦性心率降低，可能改善心脏功能。
