Abstract
Ivabradine is licensed as add-on therapy in patients with severe left ventricular systolic dysfunction (LVSD), normal sinus rhythm, and suboptimal heart rate (HR) control, but effects are not fully established. This study sought to assess the impact of ivabradine therapy on hemodynamic and functional outcome measures in all patients with LVSD. MEDLINE (1996-2017), Embase (1996-2017), Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, ClinicalTrials.gov , and ISI Web of Science were searched for randomized clinical trials (RCTs) comparing standard medical therapy (SMT) plus ivabradine to SMT alone for patients with LVSD of any severity. Each trial was assessed using the Cochrane Collaborations Risk of Bias tool. Eight RCTs with 17,823 patients were included. Add-on use of ivabradine reduced resting HR (mean difference [MD] 10.3 bpm; p < 0.001), improved ejection fraction (EF) (MD 3.6%, p < 0.001), and preserved systolic blood pressure (MD 3.4 mmHg; p = 0.09). Stratified analyses according to severity of LVSD did not influence conferred benefits on HR and EF. Small improvements were noted in exercise tolerance (standardized MD 5.9 s; p = 0.004) and peak oxygen consumption (MD 2.9 ml...Continue Reading
References
Jun 4, 1987·The New England Journal of Medicine·UNKNOWN CONSENSUS Trial Study Group
Mar 9, 1999·Circulation·R BelardinelliA Purcaro
Sep 2, 1999·The New England Journal of Medicine·B PittJ Wittes
Oct 22, 2003·The Journal of Pharmacology and Experimental Therapeutics·Patrice ColinAlain Berdeaux
Mar 11, 2008·The American Journal of Cardiology·Genevieve FlanneryHenry Krum
Sep 2, 2008·Lancet·Kim FoxUNKNOWN BEAUTIFUL Investigators
Jan 21, 2009·Circulation·Pardeep S JhundJohn J V McMurray
Aug 31, 2010·Lancet·Karl SwedbergUNKNOWN SHIFT Investigators
Oct 14, 2010·Journal of Cardiovascular Pharmacology and Therapeutics·Filippo M SarulloPietro Di Pasquale
Dec 4, 2010·Journal of the American College of Cardiology·Florian CustodisUlrich Laufs
Jul 19, 2011·International Journal of Cardiology·Maurizio VolterraniGiuseppe M C Rosano
Aug 11, 2011·Cardiovascular Drugs and Therapy·E AmosovaR Ferrari
Aug 31, 2011·European Heart Journal·Jean-Claude TardifUNKNOWN SHIFT Investigators
Aug 31, 2011·European Heart Journal·Inger EkmanKarl Swedberg
May 12, 2012·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Michael BöhmLuigi Tavazzi
May 24, 2012·Journal of the American College of Cardiology·Karl SwedbergUNKNOWN SHIFT Investigators
Mar 29, 2013·European Heart Journal·Kim FoxKarl Swedberg
Mar 30, 2013·American Heart Journal·Anh L BuiGregg C Fonarow
Aug 31, 2013·Circulation Research·Véronique L Roger
Sep 2, 2014·The New England Journal of Medicine·John J V McMurrayUNKNOWN PARADIGM-HF Investigators and Committees
Mar 4, 2015·Cardiology Journal·Serkan OrduHakan Ozhan
Apr 24, 2015·Journal of the American Heart Association·Warren K LaskeyUNKNOWN AHA Get With The Guidelines®‐Heart Failure Program
Jan 15, 2016·Circulation Journal : Official Journal of the Japanese Circulation Society·Hiroyuki TsutsuiUNKNOWN study investigators
May 22, 2016·European Heart Journal·Piotr PonikowskiUNKNOWN ESC Scientific Document Group
May 25, 2016·Journal of the American College of Cardiology·Clyde W YancyCheryl Westlake
May 25, 2016·Circulation·Mitchell A Psotka, John R Teerlink
Mar 16, 2017·World Journal of Cardiology·Mahesh Anantha NarayananGanesh Raveendran