Lee Jooyeon, Oh Jaewon, Ha Jaehyung, Lee Chan Joo, Kang Seok-Min
Cardiology Division, Severance Cardiovascular Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, South Korea.
Sci Rep. 2025 Sep 26;15(1):33043. doi: 10.1038/s41598-025-09352-w.
The effect of ivabradine on left ventricular reverse remodeling (LVRR) in heart failure with reduced ejection fraction and its correlation with achieved heart rate (HR) by ivabradine in non-ischemic dilated cardiomyopathy (NIDCM) remain uncertain. A retrospective analysis of 255 sinus rhythm NIDCM patients at a tertiary center (2012-2021) were categorized into four groups based on the ivabradine use (Iva+/-) and achieved HR at 1-year (HR+/-). The HR cut-off of 70 bpm was determined via receiver operating characteristic curve analysis for LVRR, defined as an absolute ≥ 10% improvement in LV ejection fraction (LVEF) from baseline, with a final LVEF ≥ 40%. LVRR incidence at 1-year was, 46.8% in Iva-/HR70+, 46.6% in Iva-/HR70-, 62.9% Iva+/HR70+ and 71.1% in Iva+/HR70-. Ivabradine treated patients with HR < 70 bpm had higher incidence of LVRR than those without ivabradine (Iva+/HR70-vs. Iva-/HR70+, OR 4.85, 95%CI 1.97-11.96 P = 0.001; Iva+/HR70-vs. Iva-/HR70-, OR 3.60, 95% CI 1.41-9.18, P = 0.007) after adjustment for known predictors in a multivariate model. Consistent adherence to beta-blockers and ivabradine, along with guideline-directed medical therapy (GDMT) for HF, and sex were identified as independent predictors of LVRR. Ivabradine therapy achieving HR < 70 bpm correlated with increased LVRR incidence in NIDCM patients, underscoring the role of ivabradine in HR reduction adjunctive to GDMT.
伊伐布雷定对射血分数降低的心力衰竭患者左心室逆向重构（LVRR）的影响及其与非缺血性扩张型心肌病（NIDCM）患者使用伊伐布雷定后所达到的心率（HR）的相关性仍不明确。对一家三级中心（2012年至2021年）的255例窦性心律NIDCM患者进行回顾性分析，根据伊伐布雷定的使用情况（Iva+/-）和1年时达到的心率（HR+/-）将患者分为四组。通过接受者操作特征曲线分析确定LVRR的心率临界值为70次/分，LVRR定义为左心室射血分数（LVEF）较基线绝对提高≥10%，且最终LVEF≥40%。1年时LVRR的发生率在Iva-/HR70+组为46.8%，Iva-/HR70-组为46.6%，Iva+/HR70+组为62.9%，Iva+/HR70-组为71.1%。在多变量模型中对已知预测因素进行调整后，使用伊伐布雷定且心率<70次/分的患者LVRR发生率高于未使用伊伐布雷定的患者（Iva+/HR70-与Iva-/HR70+相比，OR 4.85，95%CI 1.97-11.96，P = 0.001；Iva+/HR70-与Iva-/HR70-相比，OR 3.60，95%CI 1.41-9.18，P = 0.007）。持续坚持使用β受体阻滞剂和伊伐布雷定，以及遵循心力衰竭的指南指导药物治疗（GDMT）和性别被确定为LVRR的独立预测因素。伊伐布雷定治疗使心率<70次/分与NIDCM患者LVRR发生率增加相关，强调了伊伐布雷定在GDMT辅助降低心率方面的作用。
