%0 Journal Article
%T Effect of Ivabradine on Endothelial Function in Diastolic and Right Heart Failure Patients
%A Arturo Orea-Tejeda
%A Karla Balderas-Mu£¿oz
%A Lilia Castillo-Mart¨ªnez
%A Oscar Infante-V¨¢zquez
%A Ra¨²l Mart¨ªnez Memije
%A Candace Keirns-Davis
%A Joel Dorantes-Garc¨ªa
%A Ren¨¦ Narv¨¢ez-David
%A Zuilma V¨¢zquez-Ort¨ªz
%J Cardiology Research and Practice
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/603913
%X Background. Ivabradine is an If ion current inhibitor that has proved to reduce mortality in patients with systolic heart failure by slowing heart rate without decreasing myocardial contractility. Photoplethysmography is a simple, low-cost optical technique that can evaluate vascular function and detect changes in blood flow, pulse, and swelling of tissular microvascular space. Objective. To evaluate the effect of ivabradine on endothelial function by photoplethysmography in diastolic and right heart failure patients. Methodology. 15 patients were included (mean age of 78.1 ¡À 9.2 years) with optimally treated diastolic and right heart failure. They underwent photoplethysmography before and after induced ischemia to evaluate the wave blood flow on the finger, using the maximum amplitude time/total time (MAT/TT) index. Two measurements were made before and after oral Ivabradine (mean 12.5£¿mg a day during 6 months of followup). Results. In the study group, the MAT/TT index was 29.1 ¡À 2.2 versus 24.3 ¡À 3.2 ( ) in basal recording and 30.4 ¡À 2.1 versus 23.3 ¡À 2.9 ( ), before versus after ischemia and before versus after Ivabradine intervention, respectively. Conclusions. Ivabradine administration improves endothelial function (shear stress) in diastolic and right heart failure patients. 1. Background Diastolic dysfunction has been associated with symptoms of congestive heart failure in patients with preserved left ventricular ejection fraction [1]. In the largest single-center study with approximately 36, 000 outpatients with normal LVEF, some authors have shown that diastolic dysfunction is an independent predictor of all-cause mortality [2]. In outpatients with heart failure with preserved ejection fraction (HFpEF) at the baseline echocardiogram, worsening of diastolic function in a follow-up study is also an independent predictor of all-cause mortality [3]. In addition, Achong showed that improvement in diastolic function was associated with increased survival ( ) in a mixed cohort of inpatients and outpatients with normal or mild systolic dysfunction [4], while the more advanced the stage is, the higher the filling pressures and the worse the outcomes are [5]. In patients with atrial fibrillation, if diastolic function was assessed, it was based on deceleration time of mitral E-wave velocity and tissue Doppler imaging (i.e., peak early mitral inflow velocity/diastolic early tissue velocity [E/e¡ä]) [6]. Ivabradine added to recommended treatment, improved the outcome of heart failure patients reducing cardiovascular death and hospitalizations rate [7]. In
%U http://www.hindawi.com/journals/crp/2013/603913/