Effects of selective heart rate reduction with ivabradine on LV function and central hemodynamics in patients with chronic coronary syndrome

Background. The use of b- blockers in acute coronary syndrome (ACS) is recommended for all patients, who has not contraindications. The study of the effects of esmolol during percutaneous coronary intervention (PCI) remains relevant. Objective. To evaluate the features of the effect of esmolol (Biblock, “YURiA-PHARM”) on heart rate and blood pressure in patients with ACS during PCI.Materials and methods. The study included 30 patients, 15 men and 15 women, who were hospitalized in a specialized cardiology department with ACS with elevation of the ST segment. All patients underwent a general clinical examination, ECG recording in 12 leads, PCI according to the standard protocol with ECG and blood pressure monitoring. All patients were given infusion of esmolol before the standard therapy. The level of heart rate reduction, systolic blood pressure (SBP), diastolic blood pressure (DBP), the correlation of heart rate reduction during esmolol infusion with the clinical and functional parameters of patients and the degree of coronary artery (CA) damage were analyzed.Results. Decreased heart rate and blood pressure during infusion of esmolol in all patients. Before the infusion, the heart rate av-eraged (109.8 ± 4.0) beats per minute. After the infusion – (92.8 ± 3.2) beats per minute, (p < 0.001) with an average duration of infusion (18.2 ± 2.3) minutes. The decrease in SBP levels during infusion occurred on average by (22.8 ± 2.5) mm Hg, DBP – by (16.0 ± 2.1) mm Hg, no patient had hypotension. According to the results of correlation analysis, it was found that the decrease in heart rate with the use of esmolol has a correlation with the average age of patients (r = -0.47, p = 0.0012), with the presence of multivascular coronary artery disease (r = -0.38, p = 0.002). Weaker negative correlation was found with the initial level of SBP (r = -0.28, p = 0.015), the presence of a history of myocardial infarction (r = -0.27, p = 0.005), the presence of signs of left ventricular hypertrophy (LVH) on the ECG (r = -0.22, p = 0.008), and a history of arterial hypertension that was not treated according to current recommendations (r = -0.21, p = 0.032).Conclusions. The use of esmolol solution in patients with ACS who have supraventricular tachycardia and elevated blood pressure during PCI can improve control of heart rate, SBP and DBP, a significant decrease is observed after 10 minutes of dose titration. Careful titration of esmolol solution and monitoring of ECG and blood pressure revealed no side effects, including bradycardia and hypotension, which indicates a high safety profile of the drug.

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Differential effects of heart rate reduction and β-blockade on left ventricular relaxation during exercise

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00547.2001 ◽

2002 ◽

Vol 282 (2) ◽

pp. H672-H679 ◽

Cited By ~ 64

Author(s):

Patrice Colin ◽

Bijan Ghaleh ◽

Luc Hittinger ◽

Xavier Monnet ◽

Michel Slama ◽

...

Keyword(s):

Heart Rate ◽

Left Ventricular ◽

Peak Exercise ◽

Lv Function ◽

Heart Rate Reduction ◽

Rate Reduction ◽

Similar Reduction ◽

Ventricular Relaxation ◽

Hyperpolarization Activated Current ◽

Best Fit

Left ventricular (LV) relaxation is crucial for LV function, especially during exercise. We compared the effects of increasing doses of ivabradine, a selective inward hyperpolarization-activated current inhibitor, and atenolol on the rate and extent of LV relaxation (best fit method: time constant τBF, pressure asymptote PBF) at rest and during exercise. Eight dogs were chronically instrumented to measure LV pressure and LV wall stresses. During exercise under saline, heart rate increased from 108 ± 5 to 220 ± 6 beats/min and τBF was significantly reduced from 22 ± 1 to 14 ± 2 ms. At rest, atenolol but not ivabradine increased τBF. For similar heart rate reductions during exercise, atenolol impeded the shortening of τBF (23 ± 2 ms) whereas ivabradine had no effect (15 ± 2 ms). The extent of the relaxation process (PBF) at peak exercise was increased by ivabradine, and to a greater extent by atenolol, compared with saline. Thus, for a similar reduction in heart rate at rest and during exercise, ivabradine, in contrast with atenolol, does not exert any negative lusitropic effect.

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Role of Heart Rate Reduction in the Management of Myocarditis

Current Pharmaceutical Design ◽

10.2174/1381612824666180111105923 ◽

2018 ◽

Vol 24 (3) ◽

pp. 365-378 ◽

Cited By ~ 2

Author(s):

Chen Guang-Yi ◽

Ge Li-Sha ◽

Li Yue-Chun

Keyword(s):

Heart Rate ◽

Nitrosative Stress ◽

Ventricular Remodeling ◽

Animal Experiments ◽

Viral Myocarditis ◽

Protective Effects ◽

Heart Rate Reduction ◽

Rate Reduction ◽

Beneficial Effects ◽

Biological Technique

The morbidity of myocarditis demonstrates an upward tendency by years, is commonly defined as the inflammation of myocytes and is caused by multiple factors. With the development of the molecular biological technique, great breakthroughs in the diagnosis and understanding of pathophysiological mechanisms of myocarditis have recently been achieved. Several questions remain unresolved, however, including standard treatment approaches to myocarditis, which remain controversial and ambiguous. Heart rate, as an independent risk factor, has been shown to be related to cardiac disease. Recent studies also show that the autonomic nervous system is involved in immunomodulatory myocarditis processes. Heart rate reduction treatment is recommended in myocarditis based on a number of animal experiments and clinical trials. It is possible that heart rate-lowering treatments can help to attenuate the inflammatory response and myocyte injury and reverse ventricular remodeling. However, how to execute the protective effects of heart rate reduction on myocarditis is still not clear. In this review, we discuss the pathogenesis and pathophysiological process of viral myocarditis and propose heart rate lowering as a therapeutic target for myocarditis, especially in light of the third-generation β-blockade carvedilol and funny channel blocker ivabradine. We also highlight some additional beneficial effects of such heart rate reduction agents, including anti-inflammatory, antioxidation, anti-nitrosative stress, anti-fibrosis and antiapoptosis properties.

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