The Effects of Ivabradine on Left Atrial Electromechanical Function in Patients with Systolic Heart Failure

Overview

Journal J Interv Card Electrophysiol

Publisher Springer

Date 2016 Apr 4

PMID 27039084

Citations 2

Authors

Serkan Ozturk

Selcuk Ozturk

Fatma Hizal Erdem

Alim Erdem

Selim Ayhan

Ibrahim Donmez

Mehmet Yazici

Affiliations

Soon will be listed here.

Abstract

Aim: Heart rate (HR) reduction with ivabradine improves left ventricle filling by the prolongation of the diastolic time and increases stroke volume. But, it remains unclear what ivabradine's effect is on atrial conduction time and atrial mechanical functions. The aim of our study was to evaluate in stable outpatients with systolic heart failure (HF) the 3 months effect of ivabradine on atrial conduction time and mechanical functions.

Method: We evaluated prospectively 43 (31 males, 12 females) patients with HF. Before and after treatment, all patients were evaluated by transthoracic M mode, two dimensional (2D), pulsed-wave (PW), continuous wave (CW), color flow and tissue Doppler imaging (TDI), and LA volumes were obtained apical four-chamber views by a disc's method. LA maximum volume (Vmax) at the end-systolic phase, LA minimum volume (Vmin) at the end-diastolic phase, and LA volume before atrial systole (Vp) were evaluated. The LA function parameters were calculated as follows: LA passive emptying volume = Vmax - Vp; LA passive emptying fraction = [(Vmax - Vp)/Vmax] × 100%, LA active emptying volume = Vp - Vmin; LA active emptying fraction = [(Vp - Vmin)/Vp] × 100%.

Results: Thirty men and 13 women with mean ± SD age of 63.9 ± 10.1 years were included in this study. Resting heart rate was significantly reduced after ivabradine treatment. There were no significantly difference in LVEF, and E/A before and after ivabradine treatment. LA diameter and Vmin were similar before and after ivabradine treatment (p = 0.793 and p = 0.284). However, Vmax and Vp were significantly decreased after ivabradine treatment (p = 0.040 and p = 0.012). Moreover, LA active emptying volume and LA active emptying fraction were significantly decreased after ivabradine treatment (p = 0.030 and p = 0.008). The PA lateral, septal, and tricuspid durations were significantly reduced after ivabradine treatment (p < 0.001, p < 0.001, and p = 0.002, respectively). Interatrial electromechanical delay and right intra-atrial electromechanical delay were significantly decreased after ivabradine treatment (33.7 ± 12.7 vs 26.2 ± 10.1, p = 0.001; and 14.1 ± 6.1 vs 9.2 ± 6.8, p < 0.001).

Conclusions: The present study demonstrated that adding ivabradine to the standard therapy reduced HR and improves significantly LA electrical and mechanical functions in systolic HF patients.

Citing Articles

Therapeutic Use and Molecular Aspects of Ivabradine in Cardiac Remodeling: A Review.

Kamisah Y, Che Hassan H Int J Mol Sci. 2023; 24(3).

PMID: 36769115 PMC: 9917668. DOI: 10.3390/ijms24032801.

Ivabradine as adjuvant treatment for chronic heart failure.

Benstoem C, Kalvelage C, Breuer T, Heussen N, Marx G, Stoppe C Cochrane Database Syst Rev. 2020; 11:CD013004.

PMID: 33147368 PMC: 8094176. DOI: 10.1002/14651858.CD013004.pub2.

References

Speranza L, Franceschelli S, Riccioni G . The biological effects of ivabradine in cardiovascular disease. Molecules. 2012; 17(5):4924-35. PMC: 6268753. DOI: 10.3390/molecules17054924. View

Fox K, Ford I, Steg P, Tendera M, Ferrari R . Ivabradine for patients with stable coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a randomised, double-blind, placebo-controlled trial. Lancet. 2008; 372(9641):807-16. DOI: 10.1016/S0140-6736(08)61170-8. View

Hoppe U, Beuckelmann D . Characterization of the hyperpolarization-activated inward current in isolated human atrial myocytes. Cardiovasc Res. 1998; 38(3):788-801. DOI: 10.1016/s0008-6363(98)00047-9. View

Camm A, Lau C . Electrophysiological effects of a single intravenous administration of ivabradine (S 16257) in adult patients with normal baseline electrophysiology. Drugs R D. 2003; 4(2):83-9. DOI: 10.2165/00126839-200304020-00001. View

Lai L, Su M, Lin J, Tsai C, Lin F, Chen Y . Measurement of funny current (I(f)) channel mRNA in human atrial tissue: correlation with left atrial filling pressure and atrial fibrillation. J Cardiovasc Electrophysiol. 1999; 10(7):947-53. DOI: 10.1111/j.1540-8167.1999.tb01265.x. View

Prioli A, Marino P, Lanzoni L, Zardini P . Increasing degrees of left ventricular filling impairment modulate left atrial function in humans. Am J Cardiol. 1998; 82(6):756-61. DOI: 10.1016/s0002-9149(98)00452-4. View

Lang R, Bierig M, Devereux R, Flachskampf F, Foster E, Pellikka P . Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of.... J Am Soc Echocardiogr. 2005; 18(12):1440-63. DOI: 10.1016/j.echo.2005.10.005. View

Cui Q, Zhang W, Wang H, Sun X, Wang R, Yang H . Assessment of atrial electromechanical coupling and influential factors in nonrheumatic paroxysmal atrial fibrillation. Clin Cardiol. 2008; 31(2):74-8. PMC: 6652912. DOI: 10.1002/clc.20162. View

Vilaine J, Bidouard J, Lesage L, Reure H, Peglion J . Anti-ischemic effects of ivabradine, a selective heart rate-reducing agent, in exercise-induced myocardial ischemia in pigs. J Cardiovasc Pharmacol. 2003; 42(5):688-96. DOI: 10.1097/00005344-200311000-00016. View

10.

Flannery G, Gehrig-Mills R, Billah B, Krum H . Analysis of randomized controlled trials on the effect of magnitude of heart rate reduction on clinical outcomes in patients with systolic chronic heart failure receiving beta-blockers. Am J Cardiol. 2008; 101(6):865-9. DOI: 10.1016/j.amjcard.2007.11.023. View

11.

Daubert J . Introduction to atrial fibrillation and heart failure: a mutually noxious association. Europace. 2004; 5 Suppl 1:S1-4. DOI: 10.1016/j.eupc.2004.07.002. View

12.

Anwar A, Geleijnse M, Soliman O, Nemes A, Ten Cate F . Left atrial Frank-Starling law assessed by real-time, three-dimensional echocardiographic left atrial volume changes. Heart. 2007; 93(11):1393-7. PMC: 2016907. DOI: 10.1136/hrt.2006.099366. View

13.

Swedberg K, Komajda M, Bohm M, Borer J, Ford I, Dubost-Brama A . Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study. Lancet. 2010; 376(9744):875-85. DOI: 10.1016/S0140-6736(10)61198-1. View

14.

Merckx K, de Vos C, Palmans A, Habets J, Cheriex E, Crijns H . Atrial activation time determined by transthoracic Doppler tissue imaging can be used as an estimate of the total duration of atrial electrical activation. J Am Soc Echocardiogr. 2005; 18(9):940-4. DOI: 10.1016/j.echo.2005.03.022. View

15.

Haffajee J, Lee Y, Alsheikh-Ali A, Kuvin J, Pandian N, Patel A . Pre-operative left atrial mechanical function predicts risk of atrial fibrillation following cardiac surgery. JACC Cardiovasc Imaging. 2011; 4(8):833-40. DOI: 10.1016/j.jcmg.2011.03.019. View

16.

Vasan R, Demissie S, Kimura M, Cupples L, White C, Gardner J . Association of leukocyte telomere length with echocardiographic left ventricular mass: the Framingham heart study. Circulation. 2009; 120(13):1195-202. PMC: 2857693. DOI: 10.1161/CIRCULATIONAHA.109.853895. View

17.

Shafazand M, Schaufelberger M, Lappas G, Swedberg K, Rosengren A . Survival trends in men and women with heart failure of ischaemic and non-ischaemic origin: data for the period 1987-2003 from the Swedish Hospital Discharge Registry. Eur Heart J. 2008; 30(6):671-8. DOI: 10.1093/eurheartj/ehn541. View

18.

Riccioni G . Ivabradine: an intelligent drug for the treatment of ischemic heart disease. Molecules. 2012; 17(11):13592-604. PMC: 6268242. DOI: 10.3390/molecules171113592. View

19.

Mureddu G, Cioffi G, Stefenelli C, Boccanelli A . Relationships of the appropriateness of left ventricular mass to left atrial size and function in arterial hypertension. J Cardiovasc Med (Hagerstown). 2007; 8(6):445-52. DOI: 10.2459/01.JCM.0000269718.41059.62. View

20.

Acar G, Akcay A, Sokmen A, Ozkaya M, Guler E, Sokmen G . Assessment of atrial electromechanical delay, diastolic functions, and left atrial mechanical functions in patients with type 1 diabetes mellitus. J Am Soc Echocardiogr. 2009; 22(6):732-8. DOI: 10.1016/j.echo.2009.03.028. View