Russian Heart Failure Journal 2010year Ivabradine as an alternative to beta-blockers in treatment of chronic heart failure FC III


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2010/

Ivabradine as an alternative to beta-blockers in treatment of chronic heart failure FC III

Kanorsky S. G., Tregubov V. G., Kumacheva E. S., Pokrovskiy V. M.

Keywords: ivabradine, metoprolol succinate, regulatory and adaptive status, cardio-respiratory synchronicity, CHF

DOI: 10.18087/rhfj.2010.6.1421

Urgency. Chronic heart failure is common, serious, unfavorable consequence of all cardiovascular disease. β-blockers (BB) usage in patients with CHF can be limited due to their negative effect on bronchus, peripheral blood vessels and erectile function, presence of bradycardia, hypertension, severe systolic dysfunction. This justifies the use of drugs that control heart rate, have positive effect on target organs, do not impair the functional organism state – the capacity for regulation and adaptation. For objective quantitative assessment of regulatory and adaptive status (RAS) a test of cardio-respiratory synchronization (SDS) was proposed, taking into account the interaction between two most important functions of vegetative supply – cardiac and respiratory. Aim. To determine the efficacy of combined treatment with ivabradine of CHF FC III and CAD and / or essential hypertension (EH) III stage, by assessment of RAS. In such cases an inhibitor of If -channel ivabradine can be an alternative to BB. Materials and methods. The study included 100 patients with CHF FC III and CAD and / or EH III stage, randomized into two groups of combined therapy. The first group (56 patients aged 62.9±1.8 years) received metoprolol succinate sustained-release (the average dose 59.1±4.5 mg / day). The second group (44 patients aged 59.4±1.3 years) received If -channel inhibitor ivabradine (the average dose 12.1±2.3 mg / day) in case of impossibility to use BB. At baseline and after 6 months further examination was performed: treadmill test with estimation of maximal oxygen consumption under load (VO2 max), echocardiography, ambulatory blood pressure monitoring, 6 min walk test, blood level of NT-proBNP, RAS test. Results. Therapy with ivabradine improved structural and functional myocardial state, increased exercise tolerance, caused positive dynamics in NT-proBNP plasma levels, VO2 max, and RAS test. Thus, ivabradine can probably serve as an alternative to BB in case of impossibility of their use in patients with CHF FC III, including patients with decreased LVEF.
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Kanorsky S. G., Tregubov V. G., Kumacheva E. S. et al. Ivabradine as an alternative to beta-blockers in treatment of chronic heart failure FC III. Russian Heart Failure Journal. 2010;11(6):368-371.

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