Ballas Christos E, Katsouras Christos S, Siaravas Konstantinos C, Tzourtzos Ioannis, Moula Amalia I, Alexiou Christos
Department of Cardiac Surgery, University Hospital of Ioannina, 45500 Ioannina, Greece.
First Department of Cardiology, University Hospital of Ioannina, 45500 Ioannina, Greece.
J Cardiovasc Dev Dis. 2025 Jul 31;12(8):294. doi: 10.3390/jcdd12080294.
This review explores the advantages of ivabradine in the management of cardiac surgery patients, particularly highlighting its heart rate (HR)-reducing properties, its role in minimizing the impact of atrial fibrillation, and its contributions to improving left ventricular diastolic function, as well as reducing pain, stress, and anxiety. In parallel, studies provide evidence that ivabradine influences endothelial inflammatory responses through mechanisms such as biomechanical modulation. Unlike traditional beta-blockers that may induce hypotension, ivabradine selectively inhibits hyperpolarization-activated cyclic nucleotide-gated (HCN) channels, allowing for effective HR reduction without compromising blood pressure stability. This characteristic is particularly beneficial for patients at risk of atrial fibrillation post-surgery, where HR control is crucial for cardiovascular stability. This is an area in which ivabradine appears to play a role prophylactically, possibly in combination with beta-blockers. Furthermore, ivabradine has been associated with enhanced diastolic parameters in left ventricular function, reflecting its potential to improve surgical outcomes in patients with compromised heart function. In addition to its cardiovascular benefits, it appears to alleviate psychological stress and anxiety, common in postoperative settings, by moderating the neuroendocrine response to stress, thereby reducing stress-induced hormone levels. Furthermore, it has notable analgesic properties, contributing to pain management through its action on HCN channels in both the peripheral and central nervous systems. Collectively, these findings indicate that ivabradine may serve as a valuable therapeutic agent in the perioperative care of cardiac surgery patients, addressing both physiological and psychological challenges during recovery.
本综述探讨了伊伐布雷定在心脏手术患者管理中的优势，特别强调了其降低心率（HR）的特性、在最小化心房颤动影响方面的作用、对改善左心室舒张功能的贡献，以及减轻疼痛、应激和焦虑的作用。同时，研究提供了证据表明伊伐布雷定通过生物力学调节等机制影响内皮炎症反应。与可能导致低血压的传统β受体阻滞剂不同，伊伐布雷定选择性抑制超极化激活的环核苷酸门控（HCN）通道，从而在不影响血压稳定性的情况下有效降低心率。这一特性对术后有房颤风险的患者尤为有益，在这类患者中，控制心率对心血管稳定性至关重要。在这方面，伊伐布雷定似乎可起到预防性作用，可能与β受体阻滞剂联合使用。此外，伊伐布雷定与左心室功能舒张参数的改善相关，这反映了其在改善心功能受损患者手术结局方面的潜力。除了心血管益处外，它似乎还能通过调节对压力的神经内分泌反应来减轻术后常见的心理应激和焦虑，从而降低应激诱导的激素水平。此外，它具有显著的镇痛特性，通过作用于外周和中枢神经系统的HCN通道来促进疼痛管理。总的来说，这些发现表明伊伐布雷定可能是心脏手术患者围手术期护理中有价值的治疗药物，可应对恢复过程中的生理和心理挑战。
