Effect of Ivabradine on Endothelial Function in Diastolic and Right Heart Failure Patients

Abstract

Background. Ivabradine is an If ion current inhibitor that has proved to reduce mortality in patients with systolic heart failure by slowing heart rate without decreasing myocardial contractility. Photoplethysmography is a simple, low-cost optical technique that can evaluate vascular function and detect changes in blood flow, pulse, and swelling of tissular microvascular space. Objective. To evaluate the effect of ivabradine on endothelial function by photoplethysmography in diastolic and right heart failure patients. Methodology. 15 patients were included (mean age of 78.1 ± 9.2 years) with optimally treated diastolic and right heart failure. They underwent photoplethysmography before and after induced ischemia to evaluate the wave blood flow on the finger, using the maximum amplitude time/total time (MAT/TT) index. Two measurements were made before and after oral Ivabradine (mean 12.5 mg a day during 6 months of followup). Results. In the study group, the MAT/TT index was 29.1 ± 2.2 versus 24.3 ± 3.2 (P = 0.05) in basal recording and 30.4 ± 2.1 versus 23.3 ± 2.9 (P = 0.002), before versus after ischemia and before versus after Ivabradine intervention, respectively. Conclusions. Ivabradine administration improves endothelial function (shear stress) in diastolic and right heart failure patients.

Endothelial dysfunction: developmental mechanisms and therapeutic strategies

“…One of the controversial candidates for the treatment of ED is the if-channel inhibitor ivabradine. A number of studies have revealed its positive effect on both endothelium-dependent vasodilation and eNOS expression in both animals and humans (Bolduc et al 2011;Musikhina et al 2012;Orea-Tejeda et al 2013). However, the authors of some studies note that there was no significant improvement in vasodilation under the action of ivabradine in patients with microvascular angina (Villano et al 2013), as well as in patients with other forms of coronary heart disease (Jochmann et al 2014) or type II diabetes (Nerla et al 2012).…”

Helyzeti előny vagy valódi többletérték? Időszerű-e még a „klasszikus” ß-blokkoló feltitrálási stratégia?

“…A "stressz hypokalaemia" is ß 2 -receptor stimuláció által mediált folyamat (a K + -transzport a sejtbe extracelluláris hypokalaemiát eredményez). (29,30,31).…”

An overview of endothelial dysfunction in diabetes

“…Other new treatment options for improving endothelial function are also being researched currently. These include the eNOS transcription enhancer AVE3085, Ivabradine and Sphingosine-1-phosphate amongst others [41][42][43].…”