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The effects of ivabradine on left atrial electromechanical function in patients with systolic heart failure

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Aim

Heart rate (HR) reduction with ivabradine improves left ventricle filling by the prolongation of the diastolic time and increases stroke volume. But, it remains unclear what ivabradine’s effect is on atrial conduction time and atrial mechanical functions. The aim of our study was to evaluate in stable outpatients with systolic heart failure (HF) the 3 months effect of ivabradine on atrial conduction time and mechanical functions.

Method

We evaluated prospectively 43 (31 males, 12 females) patients with HF. Before and after treatment, all patients were evaluated by transthoracic M mode, two dimensional (2D), pulsed-wave (PW), continuous wave (CW), color flow and tissue Doppler imaging (TDI), and LA volumes were obtained apical four-chamber views by a disc’s method. LA maximum volume (Vmax) at the end-systolic phase, LA minimum volume (Vmin) at the end-diastolic phase, and LA volume before atrial systole (Vp) were evaluated. The LA function parameters were calculated as follows: LA passive emptying volume = Vmax − Vp; LA passive emptying fraction = [(Vmax − Vp)/Vmax] × 100%, LA active emptying volume = Vp − Vmin; LA active emptying fraction = [(Vp − Vmin)/Vp] × 100%.

Results

Thirty men and 13 women with mean ± SD age of 63.9 ± 10.1 years were included in this study. Resting heart rate was significantly reduced after ivabradine treatment. There were no significantly difference in LVEF, and E/A before and after ivabradine treatment. LA diameter and Vmin were similar before and after ivabradine treatment (p = 0.793 and p = 0.284). However, Vmax and Vp were significantly decreased after ivabradine treatment (p = 0.040 and p = 0.012). Moreover, LA active emptying volume and LA active emptying fraction were significantly decreased after ivabradine treatment (p = 0.030 and p = 0.008). The PA lateral, septal, and tricuspid durations were significantly reduced after ivabradine treatment (p < 0.001, p < 0.001, and p = 0.002, respectively). Interatrial electromechanical delay and right intra-atrial electromechanical delay were significantly decreased after ivabradine treatment (33.7 ± 12.7 vs 26.2 ± 10.1, p = 0.001; and 14.1 ± 6.1 vs 9.2 ± 6.8, p < 0.001).

Conclusions

The present study demonstrated that adding ivabradine to the standard therapy reduced HR and improves significantly LA electrical and mechanical functions in systolic HF patients.

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References

  1. Pocock, S. J., Wang, D., Pfeffer, M. A., et al. (2006). Predictors of mortality and morbidity in patients with chronic heart failure. European Heart Journal, 27, 65–75.

    Article  PubMed  Google Scholar 

  2. Flannery, G., Gehrig-Mills, R., Billah, B., & Krum, H. (2008). Analysis of randomized controlled trials on the effect of magnitude of heart rate reduction on clinical outcomes in patients with systolic chronic heart failure receiving beta-blockers. The American Journal of Cardiology, 101, 865–869.

    Article  CAS  PubMed  Google Scholar 

  3. Speranza, L., Franceschelli, S., & Riccioni, G. (2012). The biological effects of ivabradine in cardiovascular disease. Molecules, 17(5), 4924–4935.

    Article  CAS  PubMed  Google Scholar 

  4. Riccioni, G. (2012). Ivabradine: an intelligent drug for the treatment of ischemic heart disease. Molecules, 17(11), 13592–13604.

    Article  CAS  PubMed  Google Scholar 

  5. Camm, A. J., & Lau, C. P. (2003). Electrophysiological effects of a single intravenous administration of ivabradine (S 16257) in adult patients with normal baseline electrophysiology. Drugs in R&D, 4(2), 83–89.

    Article  CAS  Google Scholar 

  6. Vilaine, J. P., Bidouard, J. P., Lesage, L., Reure, H., & Peglion, J. L. (2003). Anti-ischemic effects of ivabradine, a selective heart rate-reducing agent, in exercise-induced myocardial ischemia in pigs. Journal of cardiovascular pharmacology, 42(5), 668–696.

    Article  Google Scholar 

  7. Shafazand, M., Schaufelberger, M., Lappas, G., Swedberg, K., & Rosengren, A. (2009). Survival trends in men and women with heart failure of ischaemic and non-ischaemic origin: data for the period 1987–2003 from the Swedish Hospital Discharge Registry. European Heart Journal, 30, 671–678.

    Article  PubMed  Google Scholar 

  8. Dilaveris, P. E., Gialafos, E. J., Sideris, S. K., Theopistou, A. M., Andrikopoulos, G. K., Kyriakidis, M., Gialafos, J. E., & Toutouzas, P. K. (1998). Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. American Heart Journal, 135(5 Pt 1), 733–738.

    Article  CAS  PubMed  Google Scholar 

  9. Lang, R. M., Bierig, M., Devereux, R. B., et al. (2005). Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. Journal of the American Society of Echocardiography, 18, 1440–1463.

    Article  PubMed  Google Scholar 

  10. Vasan, R. S., Demissie, S., Kimura, M., Cupples, L. A., White, C., Gardner, J. P., Cao, X., Levy, D., Benjamin, E. J., & Aviv, A. (2009). Association of leukocyte telomere length with echocardiographic left ventricular mass: the Framingham heart study. Circulation, 120(13), 1195–1202.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Haffajee, J. A., Lee, Y., Alsheikh-Ali, A. A., Kuvin, J. T., Pandian, N. G., & Patel, A. R. (2011). Pre-operative left atrial mechanical function predicts risk of atrial fibrillation following cardiac surgery. JACC. Cardiovascular Imaging, 4, 833–840.

    Article  PubMed  Google Scholar 

  12. Acar, G., Akcay, A., Sokmen, A., et al. (2009). Assessment of atrial electromechanical delay, diastolic functions, and left atrial mechanical functions in patients with type 1 diabetes mellitus. Journal of the American Society of Echocardiography, 22, 732–738.

    Article  PubMed  Google Scholar 

  13. Merckx, K. L., De Vos, C. B., Palmans, A., Habets, J., Cheriex, E. C., Crijns, H. J., et al. (2005). Atrial activation time determined by transthoracic Doppler tissue imaging can be used as an estimate of the total duration of atrial electrical activation. Journal of the American Society of Echocardiography, 18(9), 940–944.

    Article  PubMed  Google Scholar 

  14. Cui, Q. Q., Zhang, W., Wang, H., et al. (2008). Assessment of atrial electromechanical coupling and influential factors in nonrheumatic paroxysmal atrial fibrillation. Clinical Cardiology, 31, 74–78.

    Article  PubMed  Google Scholar 

  15. Koncz, I., Szél, T., Bitay, M., Cerbai, E., Jaeger, K., Fülöp, F., Jost, N., Virág, L., Orvos, P., Tálosi, L., Kristóf, A., Baczkó, I., Papp, J. G., & Varró, A. (2011). Electrophysiological effects of ivabradine in dog and human cardiac preparations: potential antiarrhythmic actions. European Journal of Pharmacology, 668(3), 419–426.

    Article  CAS  PubMed  Google Scholar 

  16. Hoppe, U. C., & Beuckelmann, D. J. (1998). Characterization of the hyperpolarization- activated inward current in isolated human atrial myocytes. Cardiovascular Research, 38, 788–801.

    Article  CAS  PubMed  Google Scholar 

  17. Lai, L. P., Su, M. J., Lin, J. L., Tsai, C. H., Lin, F. Y., Chen, Y. S., Hwang, J. J., Huang, S. K., Tseng, Y. Z., & Lien, W. P. (1999). Measurement of funny current (I(f)) channel mRNA in human atrial tissue: correlation with left atrial filling pressure and atrial fibrillation. Journal of Cardiovascular Electrophysiology, 10, 947–953.

    Article  CAS  PubMed  Google Scholar 

  18. Fang, F., Lee, A. P., & Yu, C. M. (2014). Left atrial function in heart failure with impaired and preserved ejection fraction. Current Opinion in Cardiology, 29(5), 430–436.

    Article  PubMed  Google Scholar 

  19. Daubert, J. C. (2004). Introduction to atrial fibrillation and heart failure: a mutually noxious association. Europace, 5, S1–S4.

    Article  PubMed  Google Scholar 

  20. Anwar, A. M., Geleijnse, M. L., Soliman, O. I., et al. (2007). Left atrial Frank-Starling law assessed by real-time, three-dimensional echocardiographic left atrial volume changes. Heart, 93(11), 1393–1397.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Prioli, A., Marino, P., Lanzoni, L., & Zardini, P. (1998). Increasing degrees of left ventricular filling impairment modulate left atrial function in humans. The American Journal of Cardiology, 82(6), 756–761.

    Article  CAS  PubMed  Google Scholar 

  22. Mureddu, G. F., Cioffi, G., Stefenelli, C., & Boccanelli, A. (2007). Relationships of the appropriateness of left ventricular mass to left atrial size and function in arterial hypertension. Journal of Cardiovascular Medicine (Hagerstown, Md.), 8(6), 445–452.

    Article  Google Scholar 

  23. Swedberg, K., Komajda, M., Böhm, M., et al. (2010). SHIFT Investigators. Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study. Lancet, 376, 875–885.

    Article  CAS  PubMed  Google Scholar 

  24. Fox, K., Ford, I., & Gabriel Steg, P. (2008). Ivabradine for patients with stable coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a randomised, double-blind, placebo-controlled trial. The Lancet, 372, 807–816.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Faculty of Medicine, Department of Cardiology, Abant Izzet Baysal University, Golkoy, Bolu, 14280, Turkey

    Serkan Ozturk, Selçuk Öztürk, Fatma Hizal Erdem, Alim Erdem, Selim Ayhan, İbrahim Dönmez & Mehmet Yazıcı

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  1. Serkan Ozturk
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  2. Selçuk Öztürk
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  3. Fatma Hizal Erdem
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  4. Alim Erdem
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  5. Selim Ayhan
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  6. İbrahim Dönmez
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  7. Mehmet Yazıcı
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Correspondence to Serkan Ozturk.

Ethics declarations

All patients gave their written informed consent before inclusion. This study was approved by the Bolu Abant Izzet Baysal University Clinical Research Ethics Committee.

Conflict of interest

The authors declare that they have no conflict of interest.

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There were no external funding sources for this study.

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Ozturk, S., Öztürk, S., Erdem, F.H. et al. The effects of ivabradine on left atrial electromechanical function in patients with systolic heart failure. J Interv Card Electrophysiol 46, 253–258 (2016). https://doi.org/10.1007/s10840-016-0129-2

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  • DOI: https://doi.org/10.1007/s10840-016-0129-2

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