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Effect of ivabradine on left ventricular diastolic function of patients with heart failure with preserved ejection
Hidekazu Tanaka1, Yuki Yamauchi1, Junichi Imanishi2
1Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
Insights
Ivabradine may improve diastolic function in heart failure with preserved ejection fraction (HFpEF) patients. This study investigated ivabradine
Area of Science:
- Cardiology
- Pharmacology
Background:
- High resting heart rate (HR) is linked to adverse cardiovascular outcomes in heart failure (HF) patients.
- Ivabradine, a selective If current inhibitor, reduces HR and is effective in HF with reduced ejection fraction (HFrEF).
- The impact of HR reduction on diastolic function in HF with preserved ejection fraction (HFpEF) remains unclear.
Purpose of the Study:
- To investigate the effect of ivabradine on left ventricular (LV) diastolic function in HFpEF patients.
- To assess changes in LV diastolic function parameters, specifically E/e', after 3 months of ivabradine treatment.
Main Methods:
- A multicenter, prospective, single-arm, interventional study (IVA-PEF).
- Inclusion criteria: HFpEF with resting HR ≥75 bpm in sinus rhythm.
- Treatment: 5 mg/day ivabradine; assessment of LV diastolic function via E/e' at baseline and 3 months.
Main Results:
- Primary endpoint: change in E/e' ratio from baseline to 3 months.
- Data on the primary endpoint is pending analysis.
Conclusions:
- Findings may offer new insights into ivabradine's role in managing HFpEF.
- Further research is needed to establish the clinical utility of ivabradine in HFpEF.
Background:
High resting heart rate (HR) is a known marker of cardiovascular outcomes for heart failure (HF) patients. Ivabradine is a new class of HR lowering drug and a specific inhibitor of the If current in the sinoatrial node. Ivabradine substantially and significantly reduces major risks associated with HF when added to guideline-based treatment for left ventricular (LV) ejection fraction ≤35% and HR ≥70 bpm in sinus rhythm. On the other hand, HF with preserved ejection fraction (HFpEF) currently accounts for roughly half of all HF cases and usually presents as LV diastolic dysfunction. However, the association between HR reduction and LV diastolic function for HFpEF patients remains uncertain.
Methods/Design:
This investigation into the effect of IVAbradine on left ventricular diastolic function of patients with heart failure with Preserved Ejection Fraction (IVA-PEF) is a multicenter, prospective, uncontrolled, open-label, single assignment, and an interventional single-arm study to investigate the effect of ivabradine on LV diastolic function of HFpEF patients. The key inclusion criterion is HFpEF with resting HR ≥75bpm in sinus rhythm. After completed informed consent forms are obtained, patients will be given 5 mg/day of ivabradine during the study. LV diastolic function is assessed in terms of mitral inflow E and mitral e' annular velocities (E/e'). The primary endpoint will be defined as a change in E/e' between baseline and 3 months after the start of administration of ivabradine.
Conclusion:
The findings of our trial may provide a new perspective on ivabradine for the treatment of HFpEF.
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