EFFICACY OF IVABRADINE AND VERAPAMIL IN PATIENTS WITH DIASTOLIC HEART FAILURE CAUSED BY LEFT VENTRICLE IMPAIRED RELAXATION
https://doi.org/10.20996/1819-6446-2009-5-3-31-35
Abstract
Aim. To compare ivabradine (IB) and verapamil (VP) effects on left ventricle (LV) diastolic function in patients with diastolic heart failure (DHF) caused by left ventricle impaired relaxation.
Methods. It was comparative randomized study. 238 patients (190 men, 48 women; aged 63±10 y.o.) with DHF were randomized in two groups to receive IB (7,5 mg bid, n=119) or VP (240 mg o.d., n=119). Echocardiography (EchoCG) indices, total ischemic burden (TIB) and N-terminal fragment of pro-brain natriuretic peptide (NT-pro-BNP) were evaluated initially and after 1, 3, 6 and 12 months of therapy.
Results. After 3 months of therapy some EchoCG parameters (E/A, transmitral E wave deceleration time [EDT]) as well as TIB improved more significantly in IB group. After 6 months in IB group in comparison with VP group additional differences appeared (midwall fractional shortening; E/Em of lateral mitral annulus – 8,6±4,7 and 12,3±4,7, respectively, p<0,05; NT-pro-BNP – 91,7±4,3 pg/ml and 128±7,6 pg/ml, respectively, p<0.01) or became stronger (TIB, E/A and EDT). The differences persisted after 12 months of follow up. Besides a number of patients required hospitalization were less in IB group in comparison with VP group (11 vs 19, respectively, p<0.05).
Conclusion. Both IB and VP improved diastolic function and reduced heart rate, ischemia time, NT-pro-BNP levels and hospitalization rate in patients with DHF. However, IB compared with VP has more prominent effect on these parameters.
About the Authors
K. G. Adamyan
Research Institute for Cardiology
Armenia
ul. P. Sevaka 5, Erevan 0044
Armenia
ul. P. Sevaka 5, Erevan 0044
A. L. Chilingarian
Research Institute for Cardiology
Armenia
ul. P. Sevaka 5, Erevan 0044
Armenia
ul. P. Sevaka 5, Erevan 0044
References
1. Grossman W. Diastolic dysfunction in congestive heart failure. N Engl J Med 1991;325(22):1557-64.
2. Vasan R.S., Larson M.G., Benjamin E.F. et al. Congestive heart failure in subjects with normal versus reduced left ventricular ejection fraction: prevalence and mortality in a population-based cohort. J Am Coll Cardiol 1999;33(7):1948–55.
3. Senni M., Tribouilloy C.M., Rodeheffer R.J. et al. Congestive heart failure in the community: a study of all incident cases in Olmsted County, Minnesota, in 1991. Circulation 1998;98(21):2282–9.
4. Mosterd A., Hoes A.W., de Bruyne M.C. et al. Prevalence of heart failure and left ventricular dysfunction in the general population: the Rotterdam Study. Eur Heart J 1999;20(6):447–55.
5. Dauterman K.W., Massie B.M., Gheorghiade M. Heart failure associated with preserved systolic function: a common and costly clinical entity. Am Heart J 1998;135 (6 Pt 2 Su):S310–9.
6. Brutsaert D.L., Sys S.U., Gillebert T.C. Diastolic failure: pathophysiology and therapeutic implications. J Am Coll Cardiol 1993;22(1):318-25.
7. Hatle L. How to diagnose diastolic heart failure a consensus statement. Eur Heart J 2007;28(20):2421-3.
8. Zile M.R., Brutsaert D.L. New concepts in diastolic dysfunction and diastolic heart failure: part I: diagnosis, prognosis, and measurements of diastolic function. Circulation 2002;105(11):1387-93.
9. Zile M.R., Baicu C.F., Gaasch W.H. Diastolic heart failure – abnormalities in active relaxation and passive stiffness of the left ventricle. N Engl J Med 2004; 350(19):1953-9.
10. Jensen K.T., Carstens J., Ivarsen P., Pedersen E.B. A new, fast and reliable radioimmunoassay of brain natriuretic peptide in human plasma. Reference values in healthy subjects and in patients with different diseases. Scand J Clin Lab Invest 1997;57(6):529-40.
11. Tardif J.C., Ford I., Tendera M., Bourassa M.G., Fox K; INITIATIVE Investigators. Efficacy of ivabradine, a new selective I(f) inhibitor, compared with atenolol in patients with chronic stable angina. Eur Heart J 2005;26(23):2529-36.
12. De Rosa M.L., Giordano A., Melfi M. et al. Antianginal efficacy over 24 hours and exercise hemodynamic effects of once daily sustained-release 300 mg diltiazem and 240 mg verapamil in stable angina pectoris. Int J Cardiol 1998;63(1):27-35.
13. Gutierrez C., Blanchard D.G. Diastolic heart failure: challenges for diagnosis and treatment. Am Pham Physician 2004;69:2609-16.
14. Satpathy C., Mishra T.K., Satpathy R., et al. Diagnosis and management of diastolic dysfunction and heart failure. Am Fam Physician 2006;73:841- 6.
15. Colin P., Ghaleh B., Hittinger L. et al. Differential effects of heart rate reduction and beta-blockade on left ventricular relaxation during exercise. Am J Physiol Heart Circ Physiol 2002;282(2):H672-9.
16. Hess O.M., Murakami T., Krayenbuehl H.P. Does verapamil improve left ventricular function in patients with myocardial hypertrophy? Circulation 1986;74(3):530-43. 17. Nishimura R.A., Schwartz R.S., Holmes D.R. Jr, Tajik A.J. Failure of calcium channel blockers to improve ventricular relaxation in humans. J Am Coll Cardiol 1993;21(1):182-8.
17. Aronow W.S. Drug treatment of systolic and of diastolic heart failure in elderly persons. J Gerontol A Biol Sci Med Sci 2005;60(12):1597-605.
18. Mitsunami K., Inoue S., Maeda K. et al. Three-month effects of candesartan cilexetil, an angiotensin II type 1 (AT1) receptor antagonist, on left ventricular mass and hemodynamics in patients with essential hypertension. Cardiovasc Drugs Ther 1998;12(5):469-74.
19. Warner J.G. Jr, Metzger D.C., Kitzman D.W. et al. Losartan improves exercise tolerance in patients with diastolic dysfunction and a hypertensive response to exercise. J Am Coll Cardiol 1999;33(6):1567-72.
20. Simon L., Ghaleh B., Puybasset L. et al. Coronary and hemodynamic effects of S 16257, a new bradycardic agent, in resting and exercising conscious dogs. J Pharmacol Exp Ther 1995;275(2):659-66.
21. Maisel A.S., McCord J., Nowak R.M. et al. Bedside B-Type natriuretic peptide in the emergency diagnosis of heart failure with reduced or preserved ejection fraction. Results from the Breathing Not Properly Multinational Study. J Am Coll Cardiol 2003;41(11):2010-7.
22. de Lemos J.A., Morrow D.A., Bentley J.H. et al. The prognostic value of Btype natriuretic peptide in patients with acute coronary syndromes. N Engl J Med 2001;345(14):1014-21.
Review
For citations:
Adamyan K.G., Chilingarian A.L. EFFICACY OF IVABRADINE AND VERAPAMIL IN PATIENTS WITH DIASTOLIC HEART FAILURE CAUSED BY LEFT VENTRICLE IMPAIRED RELAXATION. Rational Pharmacotherapy in Cardiology. 2009;5(3):31-35. (In Russ.) https://doi.org/10.20996/1819-6446-2009-5-3-31-35
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