Ivabradine for Chemotherapy-Related Cardiac Dysfunction in Breast Cancer

Abstract

A 55-year-old woman with stage IV breast cancer was diagnosed with heart failure. Her left ventricular ejection fraction (LVEF) had decreased to 37.2%. Chemotherapy-related cardiac dysfunction (CTRCD) was suspected, and standard treatment for heart failure was initiated. After five months, her LVEF remained below 50% since she could not tolerate beta-blockers. Ivabradine was introduced, which remarkably improved her LVEF to 72.6% in only three months. Her myocardium was not dilated, which may be the reason that ivabradine was effective. Ivabradine has shown to be safe and effective in the treatment of CTRCD, and improved activities of daily living of an advanced-stage cancer patient.

The impact of medical therapy on left ventricular strain: Current state and future perspectives

“…93 Unfortunately, the data on ivabradine impact on LV contractility are too scarce to make any conclusions; there are only some anecdotal clinical case presentations on this topic. 94 This also holds true for antiarrhythmic agent's amiodarone and dronedarone, which has demonstrated negative effect on global and segmental strain and strain rate in a rabbit model, 95 but has never been studied in in humans.…”

“…Beyond the first‐line agents for CHF treatment there is some sporadic data from experimental studies supporting the possible positive effect of ivabradine on longitudinal myocardial strain and strain rate in mouse models of acute myocardial infarction 93 . Unfortunately, the data on ivabradine impact on LV contractility are too scarce to make any conclusions; there are only some anecdotal clinical case presentations on this topic 94 . This also holds true for antiarrhythmic agent's amiodarone and dronedarone, which has demonstrated negative effect on global and segmental strain and strain rate in a rabbit model, 95 but has never been studied in in humans.…”