Tags

Type your tag names separated by a space and hit enter

Effect of If-channel inhibition on hemodynamic status and exercise tolerance in heart failure with preserved ejection fraction: a randomized trial.
J Am Coll Cardiol. 2013 Oct 08; 62(15):1330-8.JACC

Abstract

OBJECTIVES

The aim of this study was to test the effects of treatment with ivabradine on exercise capacity and left ventricular filling in patients with heart failure with preserved ejection fraction (HFpEF).

BACKGROUND

Because symptoms of HFpEF are typically exertional, optimization of diastolic filling time by controlling heart rate may delay the onset of symptoms.

METHODS

Sixty-one patients with HFpEF were randomly assigned to ivabradine 5 mg twice daily (n = 30) or placebo (n = 31) for 7 days in this double-blind trial. Cardiopulmonary exercise testing with echocardiographic assessment of myocardial function and left ventricular filling were undertaken at rest and after exercise.

RESULTS

The ivabradine group demonstrated significant improvement between baseline and follow-up exercise capacity (4.2 ± 1.8 METs vs. 5.7 ± 1.9 METs, p = 0.001) and peak oxygen uptake (14.0 ± 6.1 ml/min/kg vs. 17.0 ± 3.3 ml/min/kg, p = 0.001), with simultaneous reduction in exercise-induced increase in the ratio of peak early diastolic mitral flow velocity to peak early diastolic mitral annular velocity (3.1 ± 2.7 vs. 1.3 ± 2.0, p = 0.004). Work load-corrected chronotropic response (the difference in heart rate at the same exercise time at the baseline and follow-up tests) showed a slower increase in heart rate during exercise than in the placebo-treated group. Therapy with ivabradine (β = 0.34, p = 0.04) and change with treatment in exertional increase in the ratio of peak early diastolic mitral flow velocity to peak early diastolic mitral annular velocity (β = -0.30, p = 0.02) were independent correlates of increase in exercise capacity, and therapy with ivabradine (β = 0.32, p = 0.007) was independently correlated with increase in peak oxygen uptake.

CONCLUSIONS

In patients with HFpEF, short-term treatment with ivabradine increased exercise capacity, with a contribution from improved left ventricular filling pressure response to exercise as reflected by the ratio of peak early diastolic mitral flow velocity to peak early diastolic mitral annular velocity. Because this patient population is symptomatic on exertion, therapeutic treatments targeting abnormal exercise hemodynamic status may prove useful. (Use of Exercise and Medical Therapies to Improve Cardiac Function Among Patients With Exertional Shortness of Breath Due to Lung Congestion; ACTRN12610001087044).

Authors+Show Affiliations

Wroclaw Medical University, Wroclaw, Poland.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

23916925

Citation

Kosmala, Wojciech, et al. "Effect of If-channel Inhibition On Hemodynamic Status and Exercise Tolerance in Heart Failure With Preserved Ejection Fraction: a Randomized Trial." Journal of the American College of Cardiology, vol. 62, no. 15, 2013, pp. 1330-8.
Kosmala W, Holland DJ, Rojek A, et al. Effect of If-channel inhibition on hemodynamic status and exercise tolerance in heart failure with preserved ejection fraction: a randomized trial. J Am Coll Cardiol. 2013;62(15):1330-8.
Kosmala, W., Holland, D. J., Rojek, A., Wright, L., Przewlocka-Kosmala, M., & Marwick, T. H. (2013). Effect of If-channel inhibition on hemodynamic status and exercise tolerance in heart failure with preserved ejection fraction: a randomized trial. Journal of the American College of Cardiology, 62(15), 1330-8. https://doi.org/10.1016/j.jacc.2013.06.043
Kosmala W, et al. Effect of If-channel Inhibition On Hemodynamic Status and Exercise Tolerance in Heart Failure With Preserved Ejection Fraction: a Randomized Trial. J Am Coll Cardiol. 2013 Oct 8;62(15):1330-8. PubMed PMID: 23916925.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of If-channel inhibition on hemodynamic status and exercise tolerance in heart failure with preserved ejection fraction: a randomized trial. AU - Kosmala,Wojciech, AU - Holland,David J, AU - Rojek,Aleksandra, AU - Wright,Leah, AU - Przewlocka-Kosmala,Monika, AU - Marwick,Thomas H, Y1 - 2013/07/31/ PY - 2013/03/26/received PY - 2013/05/22/revised PY - 2013/06/13/accepted PY - 2013/8/7/entrez PY - 2013/8/7/pubmed PY - 2013/12/16/medline KW - A KW - BNP KW - CI KW - E KW - HFpEF KW - I(f) KW - ICC KW - LV KW - MET KW - Vo(2) KW - WCCR KW - brain natriuretic peptide KW - confidence interval KW - diastolic function KW - e′ KW - heart failure with preserved ejection fraction KW - intraclass correlation coefficient KW - inward “funny” KW - ivabradine KW - late diastolic mitral flow velocity KW - left ventricular KW - metabolic equivalent KW - oxygen uptake KW - peak early diastolic mitral annular velocity KW - peak early diastolic mitral flow velocity KW - work load–corrected chronotropic response SP - 1330 EP - 8 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 62 IS - 15 N2 - OBJECTIVES: The aim of this study was to test the effects of treatment with ivabradine on exercise capacity and left ventricular filling in patients with heart failure with preserved ejection fraction (HFpEF). BACKGROUND: Because symptoms of HFpEF are typically exertional, optimization of diastolic filling time by controlling heart rate may delay the onset of symptoms. METHODS: Sixty-one patients with HFpEF were randomly assigned to ivabradine 5 mg twice daily (n = 30) or placebo (n = 31) for 7 days in this double-blind trial. Cardiopulmonary exercise testing with echocardiographic assessment of myocardial function and left ventricular filling were undertaken at rest and after exercise. RESULTS: The ivabradine group demonstrated significant improvement between baseline and follow-up exercise capacity (4.2 ± 1.8 METs vs. 5.7 ± 1.9 METs, p = 0.001) and peak oxygen uptake (14.0 ± 6.1 ml/min/kg vs. 17.0 ± 3.3 ml/min/kg, p = 0.001), with simultaneous reduction in exercise-induced increase in the ratio of peak early diastolic mitral flow velocity to peak early diastolic mitral annular velocity (3.1 ± 2.7 vs. 1.3 ± 2.0, p = 0.004). Work load-corrected chronotropic response (the difference in heart rate at the same exercise time at the baseline and follow-up tests) showed a slower increase in heart rate during exercise than in the placebo-treated group. Therapy with ivabradine (β = 0.34, p = 0.04) and change with treatment in exertional increase in the ratio of peak early diastolic mitral flow velocity to peak early diastolic mitral annular velocity (β = -0.30, p = 0.02) were independent correlates of increase in exercise capacity, and therapy with ivabradine (β = 0.32, p = 0.007) was independently correlated with increase in peak oxygen uptake. CONCLUSIONS: In patients with HFpEF, short-term treatment with ivabradine increased exercise capacity, with a contribution from improved left ventricular filling pressure response to exercise as reflected by the ratio of peak early diastolic mitral flow velocity to peak early diastolic mitral annular velocity. Because this patient population is symptomatic on exertion, therapeutic treatments targeting abnormal exercise hemodynamic status may prove useful. (Use of Exercise and Medical Therapies to Improve Cardiac Function Among Patients With Exertional Shortness of Breath Due to Lung Congestion; ACTRN12610001087044). SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/23916925/Effect_of_If_channel_inhibition_on_hemodynamic_status_and_exercise_tolerance_in_heart_failure_with_preserved_ejection_fraction:_a_randomized_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(13)02772-1 DB - PRIME DP - Unbound Medicine ER -