伊伐布雷定在射血分数保留的心力衰竭患者中的作用
Role of Ivabradine in Patients with Heart Failure with Preserved Ejection Fraction.
作者信息
Nadeem Muhammad, Hassib Mohab, Aslam Hafiz M, Fatima Dania, Illahi Yasir
机构信息
Internal Medicine, Seton Hall University, St. Francis Medical Center, Trenton, USA.
Internal Medicine, Saint Francis Medical Center, Trenton, USA.
出版信息
Cureus. 2020 Feb 27;12(2):e7123. doi: 10.7759/cureus.7123.
Heart failure with preserved ejection fraction (HFpEF) accounts for 50% of patients with heart failure. HFpEF carries almost similar morbidity and mortality outcomes to heart failure with reduced ejection fraction (HFrEF). Despite many trials, no management has been shown to improve mortality outcomes in HFpEF. An elevated heart rate in patients with HFpEF has been associated with worse outcomes. Previous trials on the use of beta-blockers in reducing the heart rate in patients with HFpEF have shown worse outcomes, possibly due to the negative inotropic effects. The funny current inhibitor, ivabradine, results in a reduced heart rate without affecting inotropy. Two randomized controlled trials and one cross-over study have evaluated the use of ivabradine in HFpEF patients. The outcomes of the trials have been heterogeneous; ivabradine showed improved exercise tolerance, no change in primary endpoints was seen l, and there was a worsening in the outcomes. Our review underscores the requirement of a large randomized clinical trial in the appropriate patient population.
射血分数保留的心力衰竭（HFpEF）占心力衰竭患者的50%。HFpEF的发病率和死亡率与射血分数降低的心力衰竭（HFrEF）几乎相似。尽管进行了许多试验，但尚无治疗方法被证明能改善HFpEF患者的死亡率。HFpEF患者心率升高与更差的预后相关。先前关于使用β受体阻滞剂降低HFpEF患者心率的试验显示预后更差，可能是由于负性肌力作用。超极化激活的环核苷酸门控阳离子通道（If）电流抑制剂伊伐布雷定可降低心率而不影响心肌收缩力。两项随机对照试验和一项交叉研究评估了伊伐布雷定在HFpEF患者中的应用。试验结果存在异质性；伊伐布雷定显示运动耐量改善，主要终点未见变化，且预后恶化。我们的综述强调了在合适的患者群体中进行大型随机临床试验的必要性。
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