Evaluation of Ivabradine in Left Ventricular Dyssynchrony and Reverse Remodeling in Patients With Chronic Heart Failure

Abstract

Objectives: Ivabradine is a pharmacological agent used in patients with heart failure and sinus rhythm. Its only known pharmacological effect is to slow the heart rate. In this study, we investigated the impact of ivabradine on dyssynchrony parameters in heart failure patients. Methods: In this study, we assigned 55 patients taking medication for heart failure to receive ivabradine in addition (Group I). Twenty healthy volunteers comprised Group II. Echocardiographic measurements (dyssynchrony, left ventricular volumes and left ventricular ejection fraction) were taken at baseline, 1 month, and 3 months. Results: A total of 32 heart failure patients in Group I completed the study. There was significant improvement in dyssynchrony parameters after ivabradine treatment in Group I. Interventricular dyssynchrony (IVD) decreased from 42.0 +/- 24.4 milliseconds at baseline to 33.6 +/- 20.7 milliseconds at 1 month (P = .001) and to 30.7 +/- 19.4 milliseconds at 3 months (P < .001). Septal to posterior wall motion delay decreased from 90.3 +/- 21.4 milliseconds to 83.9 +/- 26.9 milliseconds (P = .011) at 1 month and to 81.5 +/- 27.3 milliseconds at 3 months (P = .001). Septal to lateral Ts delay (TsSL) decreased from 42.7 +/- 24.5 milliseconds to 35.8 +/- 22.6 milliseconds at 1 month (P < .001) and to 34.8 +/- 22.4 milliseconds at 3 months (P = .002). Left ventricular end-systolic volume (LVESV) decreased from 139.4 +/- 42.2 mL to 135.3 +/- 39.6 mL at 1 month (P = .006) and to 123.3 +/- 39.5 mL at 3 months (P < .001). Conclusion: The addition of ivabradine to heart failure treatment improves cardiac dyssynchrony parameters in chronic systolic heart failure patients with sinus rhythm.