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Effects of selective heart rate reduction with ivabradine on left ventricular remodelling and function: results from
Jean-Claude Tardif1, Eileen O'Meara, Michel Komajda
1Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, Quebec, Canada H1T 1C8. jean-claude.tardif@icm-mhi.org
Insights
Ivabradine effectively reduced left ventricular remodelling in heart failure patients. This treatment improved key cardiac function metrics and was associated with better clinical outcomes.
Area of Science:
- Cardiology
- Pharmacology
- Medical Imaging
Background:
- Heart failure (HF) with systolic dysfunction is characterized by left ventricular (LV) remodelling.
- Effective treatments targeting LV remodelling are crucial for improving outcomes in HF patients.
Purpose of the Study:
- To evaluate the impact of ivabradine on left ventricular remodelling in patients with chronic heart failure.
- To assess the effects of ivabradine on LV end-diastolic volume index and LV ejection fraction.
Main Methods:
- The SHIFT echocardiographic substudy enrolled patients with chronic HF, LVEF ≤35%, sinus rhythm, and resting heart rate ≥70 bpm.
- Patients received either ivabradine or placebo, in addition to standard HF therapy.
- Echocardiographic parameters were analyzed at baseline and after 8 months in 411 patients.
Main Results:
- Ivabradine significantly reduced LV end-systolic volume index (LVESVI) compared to placebo (P<0.001).
- Improvements were observed in LV end-diastolic volume index (P=0.002) and LV ejection fraction (P<0.001) with ivabradine.
- Reduced LVESVI was associated with lower rates of cardiovascular mortality or HF hospitalizations.
Conclusions:
- Ivabradine demonstrates significant efficacy in reversing cardiac remodelling in HF patients.
- The findings support ivabradine as a therapeutic option for managing HF with systolic dysfunction.
- Targeting LV remodelling with ivabradine may improve clinical outcomes in heart failure.
Aims:
The SHIFT echocardiographic substudy evaluated the effects of ivabradine on left ventricular (LV) remodelling in heart failure (HF).
Methods And Results:
Eligible patients had chronic HF and systolic dysfunction [LV ejection fraction (LVEF) ≤35%], were in sinus rhythm, and had resting heart rate ≥70 bpm. Patients were randomly allocated to ivabradine or placebo, superimposed on background therapy for HF. Complete echocardiographic data at baseline and 8 months were available for 411 patients (ivabradine 208, placebo 203). Treatment with ivabradine reduced LVESVI (primary substudy endpoint) vs. placebo [-7.0 ± 16.3 vs. -0.9 ± 17.1 mL/m(2); difference (SE), -5.8 (1.6), 95% CI -8.8 to -2.7, P< 0.001]. The reduction in LVESVI was independent of beta-blocker use, HF aetiology, and baseline LVEF. Ivabradine also improved LV end-diastolic volume index (-7.9 ± 18.9 vs. -1.8 ± 19.0 mL/m(2), P= 0.002) and LVEF (+2.4 ± 7.7 vs. -0.1 ± 8.0%, P< 0.001). The incidence of the SHIFT primary composite outcome (cardiovascular mortality or hospitalization for worsening HF) was higher in patients with LVESVI above the median (59 mL/m2) at baseline (HR 1.62, 95% CI 1.03-2.56, P= 0.04). Patients with the largest relative reductions in LVESVI had the lowest event rates.
Conclusion:
Ivabradine reverses cardiac remodelling in patients with HF and LV systolic dysfunction.
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