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Achieved targeted heart rate following ivabradine therapy correlates with left ventricular reverse remodeling in

Jooyeon Lee1, Jaewon Oh1, Jaehyung Ha1

  • 1Cardiology Division, Severance Cardiovascular Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, South Korea.

Scientific Reports
|September 26, 2025
PubMed

Insights

Ivabradine therapy improves left ventricular reverse remodeling (LVRR) in non-ischemic dilated cardiomyopathy (NIDCM) patients, especially when heart rate (HR) is reduced below 70 bpm. This HR reduction is key for enhanced LVRR outcomes in heart failure.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Heart failure with reduced ejection fraction (HFrEF) management remains challenging.
  • Left ventricular reverse remodeling (LVRR) is a key indicator of improved outcomes in HFrEF.
  • The role of ivabradine in achieving LVRR in non-ischemic dilated cardiomyopathy (NIDCM) is not fully understood.

Purpose of the Study:

  • To investigate the effect of ivabradine on LVRR in NIDCM patients.
  • To determine the correlation between achieved heart rate (HR) and LVRR in NIDCM patients treated with ivabradine.
  • To identify predictors of LVRR in NIDCM.

Main Methods:

  • Retrospective analysis of 255 NIDCM patients (2012-2021).
  • Patients categorized by ivabradine use (Iva+/-) and 1-year achieved HR (HR+/-) with a 70 bpm cut-off.
  • Multivariate analysis to identify predictors of LVRR, defined as ≥10% LVEF improvement to ≥40%.

Main Results:

  • LVRR incidence was higher in ivabradine-treated patients achieving HR < 70 bpm (71.1%) compared to other groups.
  • Ivabradine therapy with HR < 70 bpm significantly increased LVRR incidence (OR 4.85 vs. Iva-/HR70+; OR 3.60 vs. Iva-/HR70-).
  • Consistent adherence to beta-blockers, ivabradine, guideline-directed medical therapy (GDMT), and sex were independent predictors of LVRR.

Conclusions:

  • Ivabradine therapy achieving HR < 70 bpm is associated with increased LVRR incidence in NIDCM patients.
  • HR reduction by ivabradine plays a crucial role in promoting LVRR as an adjunct to GDMT.
  • Optimizing HR with ivabradine may be a valuable strategy in managing NIDCM.

Keywords:
Heart failure with reduced ejection fractionHeart rateIvabradineNon-ischemic dilated cardiomyopathyReverse remodeling

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