The role of ivabradine in diastolic heart failure with preserved ejection fraction. A doppler-echocardiographic study

Abstract

Background:Ivabradine (IVA) is effective in patients with coronary artery disease (CAD) or systolic heart failure in sinus rhythm. Its action consists in reducing heart rate (HR) and improving the time of left ventricular (LV) diastolic filling. The aim of this study was to evaluate the effects of IVA added to conventional therapy on patients with diastolic heart failure (DHF) and preserved ejection fraction (HFpEF).Methods:We evaluated 25 patients with DHF in the New York Heart Association (NYHA) Class II-III and sinus rhythm. In these, IVA per os (5 mg/twice a day) was added to the conventional medical therapy and given for 12 weeks. Immediately before the beginning of IVA therapy and 3 months later, patients underwent echocardiographic evaluation by two-dimensional (2D) ultrasound and tissue Doppler imaging (TDI). The patterns of diastolic mitral inflow and pulmonary venous flow were recorded using 2D echocardiography, while the diastolic phase of mitral flow was recorded by TDI, from the lateral mitral annulus.Results:Three months after the addition of IVA to conventional treatment, HR significantly decreased in comparison to the baseline values. On the contrary, the echocardiographic indexes of LV diastolic dysfunction improved.Conclusions:These results testify that the addition of IVA to conventional therapy in patients with HFpEF can improve LV diastolic function evaluated by 2D and tissue Doppler-echocardiographic patterns. These Doppler-echocardiographic results match with the clinical improvement of patients evaluated.

Do most patients with obesity or type 2 diabetes, and atrial fibrillation, also have undiagnosed heart failure? A critical conceptual framework for understanding mechanisms and improving diagnosis and treatment

“…Therefore, any potential benefit of pioglitazone on AF that might be expected from its effects on epicardial inflammation may be negated by its action to expand plasma volume and worsen atrial distension. Furthermore, if there is an underlying ventricular myopathy, sodium retention can lead to HF and disorders that predispose to HFpEF may increase this risk …”

Heart failure with preserved ejection fraction based on aging and comorbidities

“…However, they promote sodium retention, thereby increasing cardiac volume [ 136 ]. Sodium retention may aggravate cardiac fibrosis and hypertrophy and increases the risk of HFpEF [ 137 ]. Sodium-glucose cotransporter-2 (SGLT2) inhibitors, such as dapagliflozin and empagliflozin, achieve significantly decreased primary composite endpoint of worsened HF or cardiac mortality in patients with HFrEF, which is independent of diabetes [ 138 , 139 ].…”

Ivabradine and endothelium: an update

“…48 The effect of ivabradine was recently demonstrated positive in relation to LV diastolic function: drug-induced HR lowering led to an improvement in mitral inflow E/A ratio and deceleration time (DT) and pulmonary vein flow S/D ratio in HFpEF patients. 49 The gain in diastolic filling related to an improvement in stroke volume and LVEF. An upgrade in diastolic function was also noted in ischaemic patients undergoing exercise stress echocardiography before and after ivabradine introduction; the same was shown for chronotropic reserve and ischaemic threshold (greater duration of exercise and reduced anginal symptoms).…”