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Short-term effects of ivabradine in patients with chronic stable ischemic heart disease
Hosam Zaky1, Hind Elzein, Alawi A Alsheikh-Ali
1Dubai Heart Center, Division of Cardiology, Dubai Hospital, Dubai Health Authority, Dubai, UAE.
Insights
Ivabradine effectively reduces heart rate and improves angina symptoms and functional capacity in patients with stable coronary artery disease. This heart rate-lowering medication offers significant benefits when added to optimal medical therapy.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Ivabradine is a selective If current inhibitor.
- It possesses anti-ischemic and antianginal properties.
Purpose of the Study:
- To evaluate ivabradine's impact on heart rate, angina, and functional capacity.
- The study focused on stable coronary artery disease patients on maximal medical therapy.
Main Methods:
- Twenty stable coronary artery disease patients with heart rate ≥70 bpm were enrolled.
- Patients received ivabradine, with dosage adjustments, alongside optimal medical therapy.
- Assessments included angina classification (CCS) and functional capacity at baseline and 4 months.
Main Results:
- Ivabradine significantly reduced heart rate from 82 ± 8 to 68 ± 6 bpm (P < 0.001).
- Functional capacity improved significantly (3.5 ± 0.9 to 4.7 ± 0.7, P < 0.001).
- Angina class improved, with CCS I increasing from 10% to 50% (P = 0.01), and no symptomatic bradycardia reported.
Conclusions:
- Adding ivabradine to optimal medical therapy significantly improves anginal symptoms.
- Ivabradine enhances functional capacity in stable coronary artery disease patients.
- The treatment is well-tolerated, with no reported symptomatic bradycardia.
Introduction:
Ivabradine is a novel selective If current inhibitor with anti-ischemic and antianginal activity.
Objectives:
To assess the effect of the selective If current inhibitor ivabradine on heart rate, angina pectoris, and functional capacity in stable patients with chronic coronary artery disease on maximally tolerated medical therapy.
Materials And Methods:
Consecutive patients from the out-patient cardiology clinic with stable coronary artery disease documented by coronary angiography were included. Patients had to be on maximally tolerated medical therapy with β-blockers, angiotensin-converting enzyme inhibitors or receptor blockers (ACE-I or ARB), antiplatelets, statins, nitrates, and anti-metabolics with a baseline heart rate of at least 70 beats per minute. All patients underwent assessment of angina (Canadian Cardiovascular Society Angina Class: CCS I to IV) and functional capacity (using a validated self-administered questionnaire), at baseline and after 4 months of ivabradine therapy.
Results:
Twenty patients were enrolled (mean age 47 ± 7 years, all male, 60% with hypertension, 30% with diabetes mellitus). Patients were on optimal medical regimen of aspirin (100%), β-blocker (100%), statins (100%), clopidogrel (90%), nitrates (35%), anti-metabolics (90%), and ACE-I or ARB (95%). At baseline, the majority of patients (90%) were in CCS class II-IV. All patients were started on ivabradine 5 mg twice daily, and in 12 patients the dose was increased to 7.5 mg twice daily. After 4 months of treatment, the heart rate was significantly reduced from an average of 82 ± 8 to 68 ± 6 bpm (P < 0.001). The reduction in heart rate was accompanied by a significant improvement in functional capacity (score 3.5 ± 0.9 to 4.7 ± 0.7, P < 0.001) and angina classification; at baseline 10% of the patients were in CCS class I compared to 50% after 4 months of therapy (P = 0.01). No symptomatic bradycardia was reported with ivabradine.
Conclusion:
The addition of ivabradine to optimal medical therapy in patients with stable coronary artery disease is associated with significant improvement in anginal symptoms and functional capacity.
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