Peripartum cardiomyopathy is a form of dilated cardiomyopathy that is defined as deterioration in cardiac function presenting typically between the last month of pregnancy and up to five months ...postpartum. As with other forms of dilated cardiomyopathy, PPCM involves systolic dysfunction of the heart with a decrease of the left ventricular ejection fraction with associated congestive heart failure. In heart failure sinus tachycardia is a poor prognostic factor and the common symptom. In this paper, we presented a case treated with ivabradine which provided additional benefit in patient with acute heart failure.
Cardiovascular diseases is one of the key causes of lethality in developed countries. Coronary heart disease and arterial hypertension make significant contribution to this lethality. The above two ...diseases are often accompanied with compensatory acceleration of the heart rate (HR). At the same time long-term tachycardia is an independent risk factor of complications resultant from high consumption of oxygen, disturbed energy metabolism in cardiomyocytes, regress of heart contractility, development of cardiac failure. Heart contraction rhythm depends on electric activity of the sinus node cells which spontaneously generate action potentials (4P) present in all heart compartments and triggering contractile activity of cardiomyocytes. The study of the pacemaker cells (pC) discovered not only mechanisms responsible for AP rise and HR physiological regulation but revealed new ionic channels -f-channels involved in acceleration and lowering of the heart rate. Reduction of current along the f-channels (If-current) lowers AP generation in PC and, therefore, HR. Three groups of medicines are now used for HR lowering: beta-adrenoblockers, non-dihydropyridine calcium antagonists and recently introduced into clinical practice innovative drug ivabradin (coraxan) selectively suppressing activity of f-channels of sinus node cells and thus lowering HR. The review analyses differences in mechanisms of a negative chronotropic effect of these drugs.
To study effects of ivabradin on clinicohemodynamic and prognostic parameters in patients after myocardial infarction (MI) with systolic chronic cardiac failure (SCCF).
A population-based randomized ...prospective trial enrolled 49 patients (40 males--81.6%, mean age 63.1 +/- 8.1 years) with sinus rhythm and a longer than 3 month history of MI. The patients were randomized into 2 groups: 23 patients of group 1 received standard treatment plus ivabradin, 26 patients of group 2 received standard treatment alone. Follow-up was 36.1 +/- 6.2 months. We analysed the trend in heart rate (HR), blood pressure (BP), parameters of echocardiography, ECG, levels of electrolytes, creatinin in blood plasma, frequency of hospitalizations, recurrent non-fatal MI and lethality (combined endpoint).
In the end of the trial ivabradin significantly decreased HR from 71 to 64 b/m. Frequency of combined end point of efficacy was 30.4 and 50% in group 1 and 2, respectively. In group 1 primary end point in high baseline HR occurred more frequently than in HR < 70 b/m in 6 (50%) and 1 (9.1%) cases, respectively, but these differences were not significant (p = 0.068). In group 2 the differences were significant--9 (90%) and 4 (25%) cases, respectively (p = 0.004). By none of the parameters of ECG, plasma electrolytes, creatinine level significant intergroup differences were found.
In the same trend in BP and ECG, group 1 patients showed significant and more pronounced HR lowering than group 2 patients. Addition of ivabradin to standard treatment of SCCF after MI promoted less frequency of hospitalizations, recurrent non-fatal MI, fatal cardiovascular events. This effect was especially strong in high baseline HR.
Ivabradin je lijek za usporivanje srčane frekvencije, koji djeluje selektivnom i specifičnom inhibicijom If struje predvodnika srčanog ritma, koji regulira spontanu dijastoličku depolarizaciju u ...sinusnom čvoru i frekvenciju srca. Učinci na srce odnose se specifično na sinusni čvor, bez učinka na intraatrijska, atrioventrikulska ili intraventrikulska vremena provođenja, ni na kontraktilnost miokarda ili ventrikulsku repolarizaciju. Ivabradin je indiciran u liječenju bolesnika s kroničnim zatajivanjem srca NYHA klasifikacije II.-IV. sa sistoličkom disfunkcijom, u bolesnika u sinusnom ritmu u kojih je frekvencija ≥ 75/min, u kombinaciji sa standardnom terapijom, uključujući beta-blokator, ili kad je beta-blokator kontraindiciran ili slabo podnošljiv. U takvih bolesnika ivabradin poboljšava prognozu smanjenjem rizika od svih uzroka smrti, kardiovaskularne smrti i smrti zbog zatajivanja srca. Poboljšava svakodnevno život povećanjem podnošenja tjelesnog napora te sprječava progresiju bolesti smanjenjem volumena lijeve klijetke i poboljšanjem istisne frakcije.
U liječenju kroničnog zatajivanja srca (ZS), velikog problema suvremene medicine, postoji potreba za razvojem novih terapijskih pristupa, pa je svaki novi medikamentozni upliv u nepovoljni ...patofiziološki tijek ove bolesti vrijedan pažnje kardiologa. Nedavno je objavljeno istraživanje SHIFT (Systolic Heart failure treatment with the IF inhibitor ivabradine Trial), koje je ispitalo učinak dodatka ivabradina bolesnicima sa ZS, prethodno liječenih prema smjernicama. SHIFT je potvrdio da dodatno usporavanje srčane frekvencije ivabradinom može pojačati prednosti neurohormonalne blokade u kroničnom ZS. Na rezultate ovog istraživanja reagirala su neka svjetska kardiološka društva i to prilagođavanjem postojećih nacionalnih smjernica ili objavljivanjem konsenzusa, koji čvrsto definiraju mjesto ivabradina u liječenju bolesnika sa ZS.
PDF
