Abstract

PORCILE¹, Rafael et al. Clinical evolution and hemodynamic assessment of patients treated with ivabradina during infusion of intravenous inotropic. Insuf. card. [online]. 2015, vol.10, n.3, pp.119-125. ISSN 1852-3862.

Objective. To evaluate the hemodynamic effect of ivabradine used to reduce sinus tachycardia for the treatment of advanced heart failure under inotropic therapy. Material and methods. Between January 2011 and March 2015 we treated prospectively with ivabradine patients in sinus rhythm with over 100 pm of heart rate admitted to the critical cardiology unit for stage D heart failure with indication intravenous inotropic therapy with at least a sum of 10 γ/Kg/minute and at least 2.2 L/m² body surface of cardiac index. Shock patients were excluded or requiring mechanical ventilation or mechanical circulatory support. Measurements were made with Swan Ganz catheter before and three hours after administration of 15 mg of ivabradine enterally. Results. The study included 61 patients (39 men and 22 women) with a mean age of 65.8 years. The ejection fraction of the left ventricle was 31.8% .The average dose of intravenous inotropic drug was 15.2 γ/Kg/minute. Three hours after administration of ivabradine heart rate decreased from 121 ± 6 to 98 ± 7 (p=0.00002), slight increase cardiac output measured by thermodilution measured 4597 ± 550 mL/min to 4825 ± 535 mL/min (p=0.041). Cardiac performance measured by the cardiac index increased by the limit of statistical significance of 2.21 ± 0.3 to 2.33 ± 0.3 L/m² body surface area (p=0.052). The mean stroke volume increased significantly from 37.9 ± 5 to 49.3 ± 8 mL (p=0.00002). No significant difference in pressures records right atrium or pulmonary capillary pressures were observed; as well as calculations of systemic and pulmonary vascular resistance. No adverse drug effects were observed up to five halflives elapsed after suspending it. The 30-day mortality in this group of patients was 8.1%. Conclusions. Ivabradine is useful to moderate sinus tachycardia in advanced heart failure during inotropic therapy.

Keywords : Heart failure; Ivabradine; Sinus tachycardia; Inotropic therapy.