Cardiac and Hemodynamic Benefits: Mode of Action of Ivabradine in Heart Failure

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art_PEREIRA-BARRETTO_Cardiac_and_Hemodynamic_Benefits_Mode_of_Action_of_2015.PDF (509.75 KB)
Citações na Scopus
6
Tipo de produção
article
Data de publicação
2015
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
SPRINGER
Autores
Citação
ADVANCES IN THERAPY, v.32, n.10, p.906-919, 2015
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Heart failure has seen a number of therapeutic advances in recent years. Despite this, heart failure is still related to increasing rates of morbidity, repeated hospitalizations, and mortality. Ivabradine is a recent treatment option for heart failure. It has a mode of action that includes reduction in heart rate, and leads to improvement in outcomes related to heart failure mortality and morbidity, as demonstrated by the results of the SHIFT trial in patients with systolic heart failure, functional classes II and III on the NewYork Heart Association classification, and left ventricular ejection fraction B35%. These results are intriguing since many heart failure drugs reduce heart rate without such benefits, or with quite different effects, making it more difficult to understand the novelty of ivabradine in this setting. Many of the drugs used in heart failure modify heart rate, but most have other pathophysiological effects beyond their chronotropic action, which affect their efficacy in preventing morbidity and mortality outcomes. For instance, heart rate reduction at rest or exercise with ivabradine prolongs diastolic perfusion time, improves coronary blood flow, and increases exercise capacity. Another major difference is the increase in stroke volume observed with ivabradine, which may underlie its beneficial cardiac effects. Finally, there is mounting evidence from both preclinical and clinical studies that ivabradine has an anti-remodeling effect, improving left ventricular structures and functions. All together, these mechanisms have a positive impact on the prognosis of ivabradine-treated patients with heart failure, making a compelling argument for use of ivabradine in combination with other treatments. Funding: Servier.
Palavras-chave
Cardiology, Heart failure, Heart rate, Ivabradine, Morbidity, Mortality, Stroke volume
URI
https://observatorio.fm.usp.br/handle/OPI/12645
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Coleções
Artigos e Materiais de Revistas Científicas - FM/MCP
Artigos e Materiais de Revistas Científicas - HC/InCor
Artigos e Materiais de Revistas Científicas - ODS/03