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Short-Term Effects of Ivabradine in Patients with Chronic Stable Ischemic Heart Disease
INTRODUCTION: Ivabradine is a novel selective If current inhibitor with anti-ischemic and antianginal activity. OBJECTIVES: To assess the effect of the selective If current inhibitor ivabradine on heart rate, angina pectoris, and functional capacity in stable patients with chronic coronary artery di...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Medknow Publications & Media Pvt Ltd
2013
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3752876/ https://www.ncbi.nlm.nih.gov/pubmed/23983908 http://dx.doi.org/10.4103/1995-705X.115495 |
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author | Zaky, Hosam Elzein, Hind Alsheikh-Ali, Alawi A. Al-Mulla, Arif |
author_facet | Zaky, Hosam Elzein, Hind Alsheikh-Ali, Alawi A. Al-Mulla, Arif |
author_sort | Zaky, Hosam |
collection | PubMed |
description | INTRODUCTION: Ivabradine is a novel selective If current inhibitor with anti-ischemic and antianginal activity. OBJECTIVES: To assess the effect of the selective If current inhibitor ivabradine on heart rate, angina pectoris, and functional capacity in stable patients with chronic coronary artery disease on maximally tolerated medical therapy. MATERIALS AND METHODS: Consecutive patients from the out-patient cardiology clinic with stable coronary artery disease documented by coronary angiography were included. Patients had to be on maximally tolerated medical therapy with β-blockers, angiotensin-converting enzyme inhibitors or receptor blockers (ACE-I or ARB), antiplatelets, statins, nitrates, and anti-metabolics with a baseline heart rate of at least 70 beats per minute. All patients underwent assessment of angina (Canadian Cardiovascular Society Angina Class: CCS I to IV) and functional capacity (using a validated self-administered questionnaire), at baseline and after 4 months of ivabradine therapy. RESULTS: Twenty patients were enrolled (mean age 47 ± 7 years, all male, 60% with hypertension, 30% with diabetes mellitus). Patients were on optimal medical regimen of aspirin (100%), β-blocker (100%), statins (100%), clopidogrel (90%), nitrates (35%), anti-metabolics (90%), and ACE-I or ARB (95%). At baseline, the majority of patients (90%) were in CCS class II-IV. All patients were started on ivabradine 5 mg twice daily, and in 12 patients the dose was increased to 7.5 mg twice daily. After 4 months of treatment, the heart rate was significantly reduced from an average of 82 ± 8 to 68 ± 6 bpm (P < 0.001). The reduction in heart rate was accompanied by a significant improvement in functional capacity (score 3.5 ± 0.9 to 4.7 ± 0.7, P < 0.001) and angina classification; at baseline 10% of the patients were in CCS class I compared to 50% after 4 months of therapy (P = 0.01). No symptomatic bradycardia was reported with ivabradine. CONCLUSION: The addition of ivabradine to optimal medical therapy in patients with stable coronary artery disease is associated with significant improvement in anginal symptoms and functional capacity. |
format | Online Article Text |
id | pubmed-3752876 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | Medknow Publications & Media Pvt Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-37528762013-08-27 Short-Term Effects of Ivabradine in Patients with Chronic Stable Ischemic Heart Disease Zaky, Hosam Elzein, Hind Alsheikh-Ali, Alawi A. Al-Mulla, Arif Heart Views Original Article INTRODUCTION: Ivabradine is a novel selective If current inhibitor with anti-ischemic and antianginal activity. OBJECTIVES: To assess the effect of the selective If current inhibitor ivabradine on heart rate, angina pectoris, and functional capacity in stable patients with chronic coronary artery disease on maximally tolerated medical therapy. MATERIALS AND METHODS: Consecutive patients from the out-patient cardiology clinic with stable coronary artery disease documented by coronary angiography were included. Patients had to be on maximally tolerated medical therapy with β-blockers, angiotensin-converting enzyme inhibitors or receptor blockers (ACE-I or ARB), antiplatelets, statins, nitrates, and anti-metabolics with a baseline heart rate of at least 70 beats per minute. All patients underwent assessment of angina (Canadian Cardiovascular Society Angina Class: CCS I to IV) and functional capacity (using a validated self-administered questionnaire), at baseline and after 4 months of ivabradine therapy. RESULTS: Twenty patients were enrolled (mean age 47 ± 7 years, all male, 60% with hypertension, 30% with diabetes mellitus). Patients were on optimal medical regimen of aspirin (100%), β-blocker (100%), statins (100%), clopidogrel (90%), nitrates (35%), anti-metabolics (90%), and ACE-I or ARB (95%). At baseline, the majority of patients (90%) were in CCS class II-IV. All patients were started on ivabradine 5 mg twice daily, and in 12 patients the dose was increased to 7.5 mg twice daily. After 4 months of treatment, the heart rate was significantly reduced from an average of 82 ± 8 to 68 ± 6 bpm (P < 0.001). The reduction in heart rate was accompanied by a significant improvement in functional capacity (score 3.5 ± 0.9 to 4.7 ± 0.7, P < 0.001) and angina classification; at baseline 10% of the patients were in CCS class I compared to 50% after 4 months of therapy (P = 0.01). No symptomatic bradycardia was reported with ivabradine. CONCLUSION: The addition of ivabradine to optimal medical therapy in patients with stable coronary artery disease is associated with significant improvement in anginal symptoms and functional capacity. Medknow Publications & Media Pvt Ltd 2013 /pmc/articles/PMC3752876/ /pubmed/23983908 http://dx.doi.org/10.4103/1995-705X.115495 Text en Copyright: © Heart Views http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Zaky, Hosam Elzein, Hind Alsheikh-Ali, Alawi A. Al-Mulla, Arif Short-Term Effects of Ivabradine in Patients with Chronic Stable Ischemic Heart Disease |
title | Short-Term Effects of Ivabradine in Patients with Chronic Stable Ischemic Heart Disease |
title_full | Short-Term Effects of Ivabradine in Patients with Chronic Stable Ischemic Heart Disease |
title_fullStr | Short-Term Effects of Ivabradine in Patients with Chronic Stable Ischemic Heart Disease |
title_full_unstemmed | Short-Term Effects of Ivabradine in Patients with Chronic Stable Ischemic Heart Disease |
title_short | Short-Term Effects of Ivabradine in Patients with Chronic Stable Ischemic Heart Disease |
title_sort | short-term effects of ivabradine in patients with chronic stable ischemic heart disease |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3752876/ https://www.ncbi.nlm.nih.gov/pubmed/23983908 http://dx.doi.org/10.4103/1995-705X.115495 |
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