Heart rate manipulation in dilated cardiomyopathy: Assessing the role of Ivabradine

Raja, Deep Chandh; Kapoor, Aditya; Sinha, Archana; Kashyap, Shiridhar; Khanna, Roopali; Kumar, Sudeep; Garg, Naveen; Tewari, Satyendra; Goel, Pravin K.

doi:10.1016/j.ihj.2017.08.009

Cited by 15 publications

(28 citation statements)

References 23 publications

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“…Characteristics of the included studies on HFpEF are summarized in Table 1 [15][16][17], and those on HFrEF in Table 2 [18][19][20][21][22][23][24][25][26][27]. A total of 821 patients were enrolled in the 13 included RCTs with duration of follow-up ranging from 7 days to 6 months.…”

Section: Resultsmentioning

confidence: 99%

Effect of Ivabradine on Left Ventricular Diastolic Function, Exercise Tolerance and Quality of Life in Patients With Heart Failure: A Systemic Review and Meta-Analysis of Randomized Controlled Trials

et al. 2020

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Background: Ivabradine is a heart rate-lowering drug that selectively inhibits the funny (I f ) current of the sinoatrial node. It is currently recommended in patients with heart failure (HF) with reduced ejection fraction (HFrEF) in sinus rhythm and a heart rate of ≥ 70 beats per minute (bpm) at rest. To investigate whether ivabradine has an effect on diastolic dysfunction, exercise tolerance and quality of life (QOL), we conducted a systemic review and meta-analysis of randomized controlled trials (RCTs). Methods: We searched PubMed, EMBASE and Cochrane CentralRegister of Clinical Trials for studies on the effect of ivabradine on left ventricular (LV) diastolic dysfunction, exercise tolerance, QOL, readmission for worsening HF and mortality in both patients with HF with preserved ejection fraction (HFpEF) and HFrEF.Results: Thirteen RCTs with 881 patients met the inclusion criteria. According to the pooled analysis, for the HFpEF subgroup, treatment with ivabradine resulted in a decrease in early diastolic mitral inflow to late diastolic flow ratio (E/A) (standardized mean difference (SMD): -0.53; 95% confidence interval (CI): -0.99, -0.07; P < 0.000) and increase in peak oxygen uptake during exercise (VO 2 ) (SMD: 0.05; 95% CI: -0.35, 0.45; P < 0.00; I 2 = 95.1%). Similar effect was seen in the HFrEF subgroup with decrease in E/A ratio (SMD: -0.33; 95% CI: -0.59, -0.06; P < 0.000) and early diastolic mitral inflow to annular velocity ratio (E/e') (SMD: -1.01; 95% CI: -1.49, -0.54; P < 0.012). Ivabradine therapy increased peak VO 2 and 6-min walk test (6MWT) in HFrEF patients (SMD: 0.83; 95% CI: 0.35, 1.32; P < 0.00; I 2 = 97.5% and SMD: 1.11; 95% CI: 0.82, 1.41; P < 0.000, respectively). There was also significant reduction in Minnesota Living with Heart Failure Questionnaire (MLHFQ) score (SMD: -0.68; 95% CI: -0.91, -0.45; P < 0.000). However, there was no significant difference in readmission for worsening HF and all-cause mortality between ivabradine and control (risk ratio (RR): 1.44; 95% CI: 0.73, 2.16; P < 0.148 and RR: 0.76; 95% CI: 0.19, 1.33; P < 0.907, respectively). Conclusions:Ivabradine therapy is associated with improved LV diastolic function, increases exercise tolerance and hence QOL, but it has no significant effect on readmission for worsening HF and allcause mortality.

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Section: Resultsmentioning

confidence: 99%

Effect of Ivabradine on Left Ventricular Diastolic Function, Exercise Tolerance and Quality of Life in Patients With Heart Failure: A Systemic Review and Meta-Analysis of Randomized Controlled Trials

et al. 2020

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“…21 This HRQoL scale has been validated in several studies in patients with heart failure 22 and is available in multiple Indian vernacular languages including Hindi, Punjabi, Telugu and Marathi, making it a useful tool for estimating HRQoL in India. 23,24 Prior studies have classified a score of <24 on the MLHFQ represents a good QoL, a score $24 and < 45 represents a moderate QoL, and a score $ 45 represents a poor QoL. 21…”

Section: Health Related Quality Of Life (Hrqol) Assessmentmentioning

confidence: 99%

Left Ventricular Diastolic Dysfunction is Associated with Renal Dysfunction, Poor Survival and Low Health Related Quality of Life in Cirrhosis

Premkumar

Devurgowda

Vyas

et al. 2019

Journal of Clinical and Experimental Hepatology

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Background: The presence of left ventricular diastolic dysfunction (LVDD) in patients with cirrhosis leads to a restriction of activities and a poor health related quality of life (HRQoL), which should be taken into consideration when treating them for liver and cardiac complications. Aims: The prevalence, complications, predictors of HRQoL and survival in cirrhotic patients with LVDD were studied. Methods: We report a prospective cohort study of 145 consecutive cirrhotic patients with LVDD who were evaluated for cardiac functional status at enrollment and followed up for hepatic complications, cardiac events, outcome and HRQoL using the Minnesota Living With Heart Failure Questionnaire (MLHFQ) over a period of 2 years. Results: In total, 145 (mean age 61 years, 59% male) patients were included. Seventeen patients died with 10.5%, 22.5% and 40% mortality rates in patients with Grades 1, 2 and 3 LVDD respectively over 24 months. The parameters that were significant for predicting mortality on bivariate analysis were MELD, MELDNa, hepatic venous pressure gradient, MLHFQ, and left ventricular (LV) diastolic function (e 0 and E/e 0 ratio), but only MELD, MELDNa and E/e 0 remained significant on multivariate analysis. The E/e 0 ratio (8.7 ± 3.3 in survivors vs. 9.1 ± 2.3 in non-survivors) predicted outcome.

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“…Consistent with these evidences from large regulatory clinical trials, a study by Raja DC et al published in this issue of Indian Heart Journal, provides further evidence supporting the role of ivabradine as add-on to optimal standard management of patients with HF 19 . A total of 125 patients with non-ischemic dilated cardiomyopathy were randomized to receive ivabradine or a placebo on top of standard background medical therapy.…”

mentioning

confidence: 71%

Adding ivabradine to beta-blockers in chronic heart failure: Do not rest without lowering the resting heart rate sufficiently

Oomman

Bansal

2018

Indian Heart Journal

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Heart rate manipulation in dilated cardiomyopathy: Assessing the role of Ivabradine

Abstract: Addition of Ivabradine to standard therapy in patients with DCM and symptomatic HF and targeting a heart rate<70/min improves symptoms, quality of life and various echocardiographic parameters.

Cited by 15 publications

References 23 publications

Effect of Ivabradine on Left Ventricular Diastolic Function, Exercise Tolerance and Quality of Life in Patients With Heart Failure: A Systemic Review and Meta-Analysis of Randomized Controlled Trials

Effect of Ivabradine on Left Ventricular Diastolic Function, Exercise Tolerance and Quality of Life in Patients With Heart Failure: A Systemic Review and Meta-Analysis of Randomized Controlled Trials

Left Ventricular Diastolic Dysfunction is Associated with Renal Dysfunction, Poor Survival and Low Health Related Quality of Life in Cirrhosis

Adding ivabradine to beta-blockers in chronic heart failure: Do not rest without lowering the resting heart rate sufficiently

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