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Implication of heart rate optimization in patients with heart failure
Masakazu Hori1, Teruhiko Imamura1, Koichiro Kinugawa1
1The Second Department of Internal Medicine, University of Toyama, Toyama, Japan.
Journal of Cardiology Cases
|April 12, 2021
Summary
Heart rate reduction therapy with ivabradine improved cardiac output in a heart failure patient by reducing E-wave and A-wave overlap. This suggests optimizing heart rate may enhance outcomes in heart failure with reduced ejection fraction.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Heart failure with reduced ejection fraction (HFrEF) and sinus tachycardia often require heart rate management.
- Ivabradine is a selective If channel inhibitor that reduces heart rate.
- The optimal target heart rate for heart rate reduction therapy in HFrEF remains undefined.
Observation:
- A case study of an 80-year-old woman hospitalized for congestive heart failure with reduced left ventricular ejection fraction.
- Ivabradine administration decreased her heart rate from 100 bpm to approximately 60 bpm.
- Trans-mitral Doppler echocardiography showed diminished E-wave and A-wave overlap post-ivabradine treatment.
Findings:
- The reduction in E-wave and A-wave overlap correlated with an improvement in cardiac output.
- Heart rate optimization to minimize echocardiographic E-wave and A-wave overlap may be a therapeutic goal.
Implications:
- Minimizing E-wave and A-wave overlap through heart rate reduction therapy could potentially maximize cardiac output in heart failure patients.
- This strategy may facilitate cardiac reverse remodeling and improve clinical outcomes.
- Further research is needed to validate this therapeutic approach in larger heart failure cohorts.
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