Key result
Ivabradine is linked to fewer CV events in LV systolic dysfunction with HR ≥70 bpm.
Why the study?
The role of isolated heart rate modification in left ventricular systolic dysfunction and its impact on cardiovascular outcomes remains unclear.
Does ivabradine reduce cardiovascular events in patients with left ventricular systolic dysfunction and heart rate ≥70 beats/min?
Does ivabradine reduce cardiovascular events in patients with left ventricular systolic dysfunction and heart rate ≥70 beats/min?
While ivabradine lowers heart rate and cardiovascular events in systolic heart failure, the direct causal link between isolated heart rate reduction and improved outcomes remains unclear.
Answers are grounded in this paper and cite their sources.
Isolated HR reduction in LV systolic dysfunction remains of uncertain benefit; leaves open whether selective agents add value beyond β-blockers.
PURPOSE OF REVIEW: Resting heart rate has long been thought to be a risk factor in cardiovascular disease and a prognostic factor in heart failure. β-Blockers were originally used in heart failure for their heart rate control abilities. However, they also have negative inotropic effects contributing to their overall benefit. The role of isolated heart rate modification is unclear in left ventricular systolic dysfunction. RECENT FINDINGS: Two recent studies looked at the heart rate-lowering effects of the If, or funny current inhibitor ivabradine and its potential role in heart failure therapy. At the doses chosen for the studies, ivabradine is presumed to have only effects on heart rate with no other cardiotropic effects. Thus, the cardiovascular outcome benefits are presumed to be secondary to heart rate modification. SUMMARY: The two recent trials showed both heart rate and cardiovascular events to be significantly lower in the ivabradine-treated group of patients with left ventricular systolic dysfunction and initial heart rate at least 70 beats/min. However, neither of these trials proved causality. Hence, the link between heart rate and improved cardiovascular outcomes still remains muddled.
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Yip et al. (2015) conducted a review in left ventricular systolic dysfunction. ivabradine was evaluated on cardiovascular events. Ivabradine significantly lowered heart rate and cardiovascular events in patients with left ventricular systolic dysfunction and initial heart rate ≥70 beats/min, though causality remains unproven.
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