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Ivabradine, a novel heart rate slower: Is it a sword of double blades in patients with idiopathic dilated cardiomyopathy?Ivabradin, yeni bir kalp hızı yavaşlatıcısı: İdiyopatik dilate kardiyomiyopatili hastalarda iki tarafı keskin bir kılıç mıdır?Original Investigation Özgün Araşt›rma ABSTRACTObjective: To prospectively assess the safety and efficacy of ivabradine in patients with idiopathic dilated cardiomyopathy. Methods: We included 35 patients with idiopathic dilated cardiomyopathy with an ejection fraction (EF) <40% and heart rate >70 beats/min despite optimal medical therapy, according to the international guidelines in this prospective, non-randomized, single-arm, open-label safety study. Ivabradine was used as an add-on therapy to the maximally tolerated β-blocker in an increasing titrated dose till a target dose of 15 mg/ day or resting heart rate of 60 beats/min for 3 months. During follow-up period the safety, patient tolerance and efficacy of this drug were assessed. All patients underwent 12-lead resting electrocardiography and Holter monitoring at inclusion and after 3 months. Statistical analysis was accomplished using paired t-test and Pearson correlation analysis. Results: We found a significant reduction in the resting heart rate by a mean of 25.9±9.4%, without a significant change of blood pressure. There was no prolongation of PR, QTc or QRS durations. Ventricular ectopic activity showed significant reduction (p<0.001). There was a significant correlation between the resting heart rate, NYHA and left ventricular ejection fraction (p<0.001 for both). One patient developed photopsia and decompensation was observed in another patient. Conclusion: Ivabradine is a safe and effective drug in reducing resting heart rate, improving NYHA functional class without undesirable effects on conduction parameters or ectopic activity. (Anadolu Kardiyol Derg 2011; 11: 402-6)

Background The no-reflow phenomenon is defined as the occurrence of areas with extremely low tissue flow after reopening the target vessel. Current knowledge suggests that the no-reflow phenomenon is caused by the damage to microvascular integrity established both during ischemia and during reperfusion.. D-dimer is a final product of fibrin degradation by plasmin, the plasma concentrations of which increase in subjects with ongoing or recent thrombosis; its levels reflect the fibrin turnover and gives an indirect estimation of the size of the thrombotic mass available for fibrinolysis and the severity of hypercoagulable state. Moreover, high thrombus burden is known to be associated with no-reflow phenomenon. Objective: To determine the value of plasma D-dimer level on admission in predicting no-reflow after primary percutaneous coronary intervention in patients with acute ST segment elevation myocardial infarction, Patients and Methods The study was conducted among 100 patients with STEMI admitted in coronary care unit and coronary catheterization lab unit of cardiology department in Ain Shams University Hospital & Misr University Hospital undergone successful primary PCI. 74 patients showed normal re-flow after PCI and 26 patients showed noreflow phenomenon after PCI and D –dimer level and other clinical parematers for the no re-flow phenomenon were analysed. Results patient with high plasma D-dimer levels showed higher risk of no-reflow phenomenon compared with patients with low plasma D-dimer in predicting no-reflow. D-dimer level ranged from 210 to 776 ng/ml with mean± SD was 415.35 ± 164.91 ng/ml. (55%) of the patients had D-dimer levels &lt;500 ng/ml.and (45%) had D-dimer &gt;500ng/dl. coronary angiography showed that (74%) showed normal flow and (26%)showed no re-flow. ROC curve of the relation of no-reflow, TIMI flow and MBG grade, showed that the best cut off point for D-dimer to detect cases with no reflow was found ≥ 560 with sensitivity of 96.15%, specificity of 79.73% and area under curve (AUC) of 86.5%. Conclusion D-dimer level on admission independently predicts no-reflow after p-PCI. High D-dimer level on admission has an independent prognostic value.