Background: Ivabradine, selective If channel blocker, has been shown to reduce recurrent hospitalization due to worsening of heart failure. Role of this agent on left ventricular function in patients with ischemic heart failure is still unexplored. Aims and objectives: This study was planned to assess the effects of addition of ivabradine to optimal medical therapy(OMT) in patients of ischemic heart failure with systolic dysfunction on Left ventricular function, Exercise duration, Serum Brain Natriuretic Peptide (BNP) levels and Health-related quality of life. Methods: In this open-label, randomized, a total number of 158 patients of stable, ischemic heart failure were included and were randomly assigned into OMT group (n=80) and ivabradine group (n=78). Baseline assessments included assessment of Left ventricular dimension and Left ventricular ejection fraction (LVEF), Exercise duration (in seconds) by exercise test and QOL score assessment by Kansas City Cardiomyopathy Questionnaire (KCCQ) and Serum BNP level. In ivabradine group, patients were started on ivabradine5 mg in twice daily dose, in addition to OMT. Patients were followed up for 6 months. At the end of six months, LV dimensions, LV function, serum BNP levels, QOL and exercise duration were re-assessed. Results: At six months, though there was significant reduction of heart rate (70.60 +/- 5.06 vs 91.33 +/-8.9, p < 0.0001) and improvement of QOL score (p= 0.004) and NYHA functional Class(p= 0.007) with ivabradine group compared to OMT group, ivabradine failed to show significant improvement in LVEF(35 +/-3.71 vs 33+/-4.24, p=NS), Exercise duration (320 +/-130.6 vs 311.79 +/-103.60, p= 0.663) and BNP level (248.64 +/-175.70 vs 312.57 +/-222.6, p= 0.22). Subgroup analysis showed significant improvement in LVEF (35.71+/-2.98 vs 33.50 +/-3.73, p=0.003) in patients with ivabradine who achieved heart rate less than 70(n=25). No significant adverse effects on ivabradine therapy were noted at the end of six months. Conclusions: Ivabradine when added to optimal medical therapy, in NYHA Functional Class and QoL in patients with ischemic heart failure. Improvement of Left ventricular function also occurs in presence of adequate heart rate lowering (HR<70/ min).
Chaudhari, M. P., Chakraborty, P., Pathak, S. P., Isser, H. S., & Bansal, S. (2014). Effects of ivabradine on left ventricular function in patients with ischemic heart failure. Indian Heart Journal, 66, S83–S84. https://doi.org/10.1016/j.ihj.2014.10.232