CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 3, April 2012
AFRICA
171
From the ACC congress, 24–27 March 2012
Ivabradine shows benefit in diastolic heart failure patients with normal ejection fraction
The addition of ivabradine to optimal
medical care for those patients with heart
failure and a normal ejection fraction
(HFNEF) resulted in an improvement
in both diastolic function and exercise
capacity.
1
This study was presented at the
recent American College of Cardiology
meeting in Chicago and is important
to clinical practice because 50% of all
congestive heart failure (CHF) patients
have a normal ejection fraction, and to
date there is no evidence of an effective
treatment for improving outcome in these
patients.
In this study of more than 100 patients
in New York Heart Association (NYHA)
class II–IV and with an ejection fraction of
50% or higher, patients were randomised
to ivabradine 5 mg bid or placebo on
top of standard medical care. Ivabradine
therapy was subsequently uptitrated
to 7.5 mg bid. Clinical assessment of
NYHA class, exercise duration and
echocardiographic evaluation of diastolic
function was performed at baseline and
after two months of ivabradine therapy.
After two months of therapy, the resting
heart rate was decreased significantly
in the ivabradine-treated group, from 82
beats/min to an average of 67.5 beats/min.
Exercise and diastolic capacity improved
significantly in the ivabradine-treated
group.
REALITY registry confirms
value of ivabradine usage in
achieving targeted heart rate in
stable angina
REALITY, a German registry, was
examined by the Heart Infarction
Research Institute, Ludwigshaven and
the University of Heidelberg, to assess
the real-world capability of reaching the
recommended resting heart rate of 55 to
60 beats/min in stable angina patients.
2
Between November 2007 and July 2008,
a total of 4 047 consecutive outpatients
with stable angina and known coronary
artery disease (CAD) were enrolled in the
registry (Table 1).
Patients with stable angina were most
often male and were treated with aspirin
(83%), beta-blockers (80%), statins (83%)
and ACE inhibitors (63%). Heart rate was
a mean 66 beats/min; still above the
recommended targets of 55–60 beats/min
(measured after 5-min resting period).
Only 25% of patients achieved the
recommended target. The strongest
predictor against achieving heart rate < 60
beats/min was atrial fibrillation recorded
at enrolment, while patients receiving
ivabradine were significantly more likely
to achieve a resting heart rate < 60 beats/
min.
Ivabradine-treated patients with
mild-to-moderate mitral stenosis
show similar improvement to
beta-blocker therapy
In a small study of patients (33 patients)
in normal sinus rhythm with mild-to-
moderate mitral stenosis, ivabradine was
compared to metoprolol.
3
Patients were
allocated to maximal tolerated doses
for six weeks (metoprolol 100 mg bid,
ivabradine 10 mg bid) and then subjected
to crossover to the alternative therapy.
Ivabradine decreased the resting heart
rate and was as effective as metoprolol
in increasing exercise duration, reducing
transmitral gradient and pulmonary artery
systolic pressure in these patients.
J Aalbers
1.
De Masi De Luca G. Ivabradine and dias-
tolic heart failure. Abstract 222.424. ACC
2012.
2.
Anselm KG,
et al.
Determinants of achiev-
ing recommended resting heart rate in
stable coronary artery disease in Germany.
Results of the REALITY registry. Abstract
1206.404. ACC 2012.
3.
Aran RK,
et al
. Ivabradine produces simi-
lar improvement in exercise tolerance and
haemodynamics in patients with mild to
moderate mitral stenosis as compared to
metoprolol. Abstract 1150-252. ACC 2012.
TABLE 1. PATIENT CHARACTERISTICS IN FOUR HEART RATE QUARTILES
HR < 60 bpm
(n = 869)
(25.3%)
HR 60–64 bpm
(n = 882)
(25.6%)
HR 65–>72 bpm
(n = 907)
(26.4%)
HR > 72 bpm
(n = 7 811)
(22.7%)
Age
69
68
69
69
Female (%)
28
28
31.4
31.0
Prior MI (%)
55.5
51.2
52.1
53.5
Prior PCI (%)
54
55
54
47
Prior bypass (%)
38
33
30
29
Diabetes mellitus (%)
30
31
34
38
Multi-vessel disease (%)
62
63
62
64
LVEF 40%
10
9.7
10.2
13.9
Beta-blocker
78
83
81
74
Ivabradine
10
5.3
6
7.8
HR = heart rate; bpm = beats per min; MI = myocardial infarction; PCI = percutaneous coro-
nary intervention; LVEF = left ventricular ejection fraction.
