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Effect of ivabradine on left ventricular remodelling after reperfused myocardial infarction: A pilot study
Edouard Gerbaud1, Michel Montaudon2, Warren Chasseriaud3
1Soins intensifs cardiologiques - plateau de cardiologie interventionnelle, hôpital Haut-Lévêque, Pessac, France; Institut de rythmologie et de modélisation cardiaque LIRYC, CHU/université de Bordeaux/Inserm U1045, Pessac, France.
Insights
Adding ivabradine to guideline therapy reduced heart rate and improved left ventricular (LV) remodelling in ST-segment elevation myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (PPCI). This demonstrates ivabradine
Area of Science:
- Cardiology
- Pharmacology
- Medical Imaging
Background:
- Elevated heart rate post-ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous intervention (PPCI) correlates with increased mortality.
- Ivabradine is a heart rate-lowering agent without impact on blood pressure or contractility, known to reverse left ventricular (LV) remodelling in heart failure.
Purpose of the Study:
- To assess if ivabradine, as an adjunct to guideline-based therapy, enhances LV remodelling in STEMI patients undergoing PPCI.
Main Methods:
- A paired-cohort study of 124 STEMI patients treated with PPCI between June 2011 and July 2012.
- Ivabradine (5mg twice daily) was administered promptly post-PPCI alongside beta-blockers to achieve a heart rate below 60 bpm.
- The ivabradine group was matched with a control group based on age, sex, infarct artery, ischemia time, and initial infarct size via cardiac magnetic resonance imaging (CMR).
Main Results:
- Lower heart rates were observed in the ivabradine group compared to the control group at initial and follow-up CMR scans (P=0.02 and P=0.006, respectively).
- The ivabradine group showed a smaller increase in LV end-diastolic volume index (P=0.04) and preserved LV end-systolic volume index, unlike the control group (P=0.01).
- A significant improvement in LV ejection fraction was noted in the ivabradine group versus the control group (P=0.04).
Conclusions:
- In STEMI patients with successful reperfusion, ivabradine, when added to current guideline-based therapy, may improve LV remodelling.
Background:
Heart rate is a major determinant of myocardial oxygen demand; in ST-segment elevation myocardial infarction (STEMI), patients treated with primary percutaneous intervention (PPCI), heart rate at discharge correlates with mortality. Ivabradine is a pure heart rate-reducing agent that has no effect on blood pressure and contractility, and can reverse left ventricular (LV) remodelling in patients with heart failure.
Aims:
To evaluate whether ivabradine, when added to current guideline-based therapy, improves LV remodelling in STEMI patients treated with PPCI.
Methods:
This paired-cohort study included 124 patients between June 2011 and July 2012. Ivabradine (5mg twice daily) was given promptly after PPCI, along with beta-blockers, to obtain a heart rate<60 beats per minute (ivabradine group). This group was matched with STEMI patients treated in line with current guidelines, including beta-blockers (bisoprolol), according to age, sex, infarct-related coronary artery, ischaemia time and infarct size determined by initial cardiac magnetic resonance imaging (CMR) (control group). Statistical analyses were performed according to an intention-to-continue treatment principle. CMR data at 3 months were available for 122 patients.
Results:
Heart rate was lower in the ivabradine group than in the control group during the initial CMR (P=0.02) and the follow-up CMR (P=0.006). At the follow-up CMR, there was a smaller increase in LV end-diastolic volume index in the ivabradine group than in the control group (P=0.04). LV end-systolic volume index remained unchanged in the ivabradine group, but increased in the control group (P=0.01). There was a significant improvement in LV ejection fraction in the ivabradine group compared with in the control group (P=0.04).
Conclusions:
In successfully reperfused STEMI patients, ivabradine may improve LV remodelling when added to current guideline-based therapy.
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