Key result
Ivabradine provides anti-ischemic effects largely through heart rate reduction, but also reduces infarct size through unresolved pleiotropic mechanisms independent of heart rate.
Why the study?
Does ivabradine provide cardioprotection and anti-ischemic effects beyond heart rate reduction in myocardial ischemia?
Does ivabradine provide cardioprotection and anti-ischemic effects beyond heart rate reduction in myocardial ischemia?
Ivabradine exhibits pleiotropic cardioprotective effects, including infarct size reduction, that are independent of its primary heart rate-lowering mechanism.
May support pleiotropic infarct reduction with ivabradine; leaves open confirmation in prospective randomized trials before practice change.
The present review summarizes the experimental and clinical evidence for the anti-ischemic action of the selective bradycardic agent ivabradine. Improvements in myocardial blood flow and contractile function during experimental myocardial ischemia and the clinical anti-anginal effect are largely mediated by heart rate reduction. However, a significant reduction in infarct size by ivabradine persists in the absence of heart rate reduction, and such protection can also be recruited when ivabradine is given only during early reperfusion. The mechanisms for such pleiotropic action of ivabradine remain to be resolved.
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Heusch et al. (2011) conducted a review in Myocardial ischemia. Ivabradine was evaluated. Ivabradine provides anti-ischemic effects largely through heart rate reduction, but also reduces infarct size through unresolved pleiotropic mechanisms independent of heart rate.
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