伊伐布雷定选择性降低心率对慢性冠状动脉综合征患者左心室功能和中心血流动力学的影响。
Effects of selective heart rate reduction with ivabradine on LV function and central hemodynamics in patients with chronic coronary syndrome.
作者信息
Hohneck Anna Lena, Fries Peter, Stroeder Jonas, Schneider Günther, Schirmer Stephan Henrik, Reil Jan-Christian, Böhm Michael, Laufs Ulrich, Custodis Florian
机构信息
First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg and DZHK (German Centre for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Mannheim, Germany.
Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Saarland University, Homburg/Saar, Germany.
出版信息
Int J Cardiol Heart Vasc. 2021 Mar 23;34:100757. doi: 10.1016/j.ijcha.2021.100757. eCollection 2021 Jun.
OBJECTIVES
We assessed left ventricular (LV) function and central hemodynamic effects in patients with a heart rate (HR) at rest of ≥70 beats per minute (bpm) and chronic coronary syndrome (CCS) after long-term treatment with ivabradine compared to placebo by cardiac magnetic resonance (CMR) imaging.
METHODS AND RESULTS
In a randomized, double-blinded, prospective cross-over design, 23 patients (18 male, 5 female) were treated with ivabradine (7.5 mg bid) or placebo for 6 months. CMR imaging was performed at baseline and after 6 and 12 months to determine LV functional parameters.Mean resting HR on treatment with ivabradine was 58 ± 8.2 bpm and 70.2 ± 8.3 bpm during placebo (p < 0.0001).There was no difference in systolic LV ejection fraction (ivabradine 57.4 ± 11.2% vs placebo 53.0 ± 10.9%, p = 0.18), indexed end-diastolic (EDVi) or end-systolic volumes (ESVi). Indexed stroke volume (SVi) (ml/m) remained unchanged after treatment with ivabradine. Volume time curve parameters reflecting systolic LV function (peak ejection rate and time) were unaffected by ivabradine, while both peak filling rate (PFR) and PFR/EDV were significantly increased. Mean aortic velocity (cm/s) was significantly reduced during treatment with ivabradine (ivabradine 6.7 ± 2.7 vs placebo 9.0 ± 3.4, p = 0.01). Aortic flow parameters were correlated to parameters of vascular stiffness. The strongest correlation was revealed for mean aortic velocity with aortic distensibility (AD) (r = -0.86 [-0.90 to -0.85], p < 0.0001).
CONCLUSION
Long-term reduction of HR with ivabradine in patients with CCS improved diastolic function and reduced mean aortic flow velocity.
目的
我们通过心脏磁共振成像（CMR）评估了静息心率（HR）≥70次/分钟（bpm）的慢性冠状动脉综合征（CCS）患者在接受伊伐布雷定长期治疗后与接受安慰剂治疗后的左心室（LV）功能及中心血流动力学效应。
方法与结果
在一项随机、双盲、前瞻性交叉设计中，23例患者（18例男性，5例女性）接受伊伐布雷定（7.5mg，每日两次）或安慰剂治疗6个月。在基线、6个月和12个月时进行CMR成像以确定LV功能参数。接受伊伐布雷定治疗时的平均静息HR为58±8.2bpm，接受安慰剂治疗时为70.2±8.3bpm（p<0.0001）。左心室收缩射血分数无差异（伊伐布雷定组为57.4±11.2%，安慰剂组为53.0±10.9%，p=0.18），舒张末期容积指数（EDVi）或收缩末期容积指数（ESVi）也无差异。接受伊伐布雷定治疗后，每米体表面积的每搏输出量指数（SVi）（ml/m）保持不变。反映左心室收缩功能的容积时间曲线参数不受伊伐布雷定影响，而峰值充盈率（PFR）和PFR/EDV均显著增加。接受伊伐布雷定治疗期间，平均主动脉流速（cm/s）显著降低（伊伐布雷定组为6.7±2.7，安慰剂组为9.0±3.4，p=0.01）。主动脉血流参数与血管僵硬度参数相关。平均主动脉流速与主动脉扩张性（AD）的相关性最强（r=-0.86[-0.90至-0.85]，p<0.0001）。
结论
CCS患者使用伊伐布雷定长期降低心率可改善舒张功能并降低平均主动脉流速。
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