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Aims The SHIFT trial showed that ivabradine reduced heart rate (HR) and the risk of cardiovascular outcomes. Concerns remain over the efficacy and safety of ivabradine on heart failure (HF) due to Chagas disease (ChD). We therefore conducted a post hoc analysis of the SHIFT trial to investigate the effect of ivabradine in these patients. Methods and results SHIFT was a randomized, double‐blind, placebo‐controlled trial in symptomatic systolic stable HF, HR ≥ 70 b.p.m., and in sinus rhythm. The ChD HF subgroup included 38 patients, 20 on ivabradine, and 18 on placebo. The ChD HF subgroup showed high prevalence of bundle branch right block and, compared with the overall SHIFT population, lower systolic blood pressure; higher use of diuretics, cardiac glycosides, and antialdosterone agents; and lower use of angiotensin‐converting enzyme inhibitor/angiotensin II receptor blocker or target daily dose of beta‐blocker. ChD HF presented a poor prognosis (all‐cause mortality at 2 years was ~60%). The mean twice‐daily dose of ivabradine was 6.26 ± 1.15 mg and placebo 6.43 ± 1.55 mg. Ivabradine reduced HR from 77.9 ± 3.8 to 62.3 ± 10.1 b.p.m. (P = 0.005) and improved functional class (P = 0.02). A trend towards reduction in all‐cause death was observed in ivabradine arm vs. placebo (P = 0.07). Ivabradine was not associated with serious bradycardia, atrioventricular block, hypotension, or syncope. Conclusions ChD HF is an advanced form of HF with poor prognosis. Ivabradine was effective in reducing HR in these patients and improving functional class. Although our results are based on a very limited sample and should be interpreted with caution, they suggest that ivabradine may have a favourable benefit–risk profile in ChD HF patients.

It has been reported that growth hormone may benefit selected patients with congestive heart failure. A 63-yearold man with refractory congestive heart failure waiting for heart transplantation, depending on intravenous drugs (dobutamine) 13.4 and to 16.2ml/kg/min later). The patient was "de-listed" for heart transplantation. Growth hormone may benefit selected patients with refractory heart failure.Heart failure remains a high mortality and morbidity syndrome despite advances in management 1 . Besides its relative effectiveness, the clinical use of conventional or newer drugs is sometimes limited by clinical status of the patient, pharmacological intolerance or because the drug is under investigation 2 . The use of surgical procedures, such as heart transplantation, cardiomyoplasty, partial left ventriculectomy and cardiac pacemakers, is limited by donor scarcity, rigid selection criteria, graft degeneration or by lack of knowledge of accurate criteria to select patients who have chance of benefiting from a given modality of treatment 1,3,4 . Among neurohormonal changes in congestive heart failure, fall or elevation in growth hormone levels and changes in IGF-1 (somatomedin C) hormonal axis have been described, with inappropriate (low/normal) IGF-1 level in relation to growth hormone level [5][6][7][8] . Growth hormone has a widespread metabolic effect and influences the control of heart stress and performance, through activation of somatomedins, especially IGF-1 6 . It has been suggested that resistance to growth hormone might occur in heart failure 9 . It was proposed that growth hormone might be useful in patients with heart failure, and the purpose of this report is to describe its effect optimizing the therapy of refractory heart failure, in a patient receiving intravenous inotropic drugs. Case reportA 63-year-old white man, referred to heart transplantation due to refractory heart failure, was admitted into the hospital in July 23, 1998. He had suffered an acute myocardial infarction in 1988 and underwent coronary artery bypass surgery in October 1988. He had already been submitted to prostatectomy in July 10, 1997, due to prostate adenocarcinoma. He had been asymptomatic until January 1998, when he began to complain of exertional dyspnea. Coronary arteriography was performed in April 09, 1998 and showed total occlusion of both left anterior descending and left circumflex arteries, a proximal 70 % stenosis of a left marginal branch, a severe proximal stenosis of the right coronary artery, total ostial occlusion of two saphenous vein grafts (from the aorta to a marginal branch and from the aorta to the right coronary artery) and another saphenous vein graft, to the anterior descending artery, free of significant narrowing, with a satisfactory aspect. The patient underwent a successful percutaneous transluminal coronary angioplasty of the right coronary artery with stent implantation, but his symptoms did not improve. Laboratory evaluation showed total cholesterol of 154 mg/dl, HDL-cholesterol of 51 mg/d...