Alcaraz-Guzmán Alejandro, Amaro-Palomo Eder Jonathan, Ruiz-Beltrán Arturo Maximiliano, Díaz-Herrera Braiana Ángeles, Neri-Bale Raúl Rodrigo, Hernández-Bravo Lilia, Candia-Ramírez Manuel A, Gopar-Nieto Rodrigo, González-Pacheco Héctor, Sierra-Lara Martinez Jorge Daniel, Arias-Mendoza Alexandra, Araiza-Garaygordobil Diego
Coronary Care Unit, National Institute of Cardiology "Ignacio Chávez", Mexico City, Mexico. Coronary Care Unit National Institute of Cardiology "Ignacio Chávez" Mexico City Mexico.
Arch Peru Cardiol Cir Cardiovasc. 2024 Jun 24;5(2):e342. doi: 10.47487/apcyccv.v5i2.342. eCollection 2024 Apr-Jun.
. Acute myocardial infarction-related cardiogenic shock (AMI-CS) is often accompanied by tachycardia, which, in turn, increases myocardial oxygen consumption and hinders the use of ventricular assist devices, such as intra-aortic balloon pump. Evidence suggests that ivabradine may reduce heart rate (HR) without affecting other hemodynamic parameters. The aim of the present study was to determine the effect of ivabradine on reducing HR and changes in other hemodynamic parameters such as cardiac index (CI), in patients with AMI-CS and tachycardia.
. A single-center, open label, randomized clinical trial included patients diagnosed with AMI-CS and tachycardia with >100 beats per minute (BPM). Heart rate, cardiac index, and other hemodynamic parameters measured by pulmonary flotation catheter were compared at 0, 6, 12, 24, and 48 hours after randomization.
. A total of 12 patients were randomized; 6 received standard therapy, and 6 received ivabradine in addition to standard therapy. Baseline clinical characteristics were similar at randomization. A statistically significant lower heart rate was found at 12 hours (p=0.003) and 48 hours (p=0.029) after randomization, with differences of -23.3 (-8.2 to -38.4) BPM and -12.6 (-0.5 to -25.9) BPM, respectively. No differences in cardiac index, or any other evaluated hemodynamic parameters, length of hospital stay, nor mortality rate were noted between both groups.
. The use of ivabradine in patients with AMI-CS was associated with a significant reduction in heart rate at 12 and 48 h, without affecting other hemodynamic parameters.
急性心肌梗死相关的心源性休克（AMI-CS）常伴有心动过速，而心动过速反过来又会增加心肌耗氧量，并妨碍使用诸如主动脉内球囊泵等心室辅助装置。有证据表明，伊伐布雷定可能降低心率（HR）而不影响其他血流动力学参数。本研究的目的是确定伊伐布雷定对降低AMI-CS合并心动过速患者心率及其他血流动力学参数如心脏指数（CI）变化的影响。
一项单中心、开放标签、随机临床试验纳入了诊断为AMI-CS且心率>100次/分钟（BPM）的心动过速患者。在随机分组后0、6、12、24和48小时，比较通过肺动脉漂浮导管测量的心率、心脏指数及其他血流动力学参数。
共12例患者被随机分组；6例接受标准治疗，6例在标准治疗基础上接受伊伐布雷定治疗。随机分组时基线临床特征相似。随机分组后12小时（p=0.003）和48小时（p=0.029）心率有统计学意义的显著降低，差异分别为-23.3（-8.2至-38.4）BPM和-12.6（-0.5至-25.9）BPM。两组在心脏指数、或任何其他评估的血流动力学参数、住院时间及死亡率方面均未观察到差异。
在AMI-CS患者中使用伊伐布雷定与12小时和48小时时心率显著降低相关，且不影响其他血流动力学参数。
