Open AccessEarly NT‐proBNP Decrease With Ivabradine in Ambulatory Patients With Systolic Heart Failure
Author(s) -
Sargento Luis,
Satendra Milan,
Longo Susana,
Lousada Nuno,
Palma dos Reis Roberto
Publication year - 2013
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22183
Subject(s) - ivabradine , medicine , cardiology , heart failure , ejection fraction , sinus rhythm , ventricle , heart rate , ambulatory , spironolactone , natriuretic peptide , blood pressure , atrial fibrillation
Background Heart rate ( HR ) reduction in patients with systolic heart failure ( HF ) is a cornerstone of current therapy. The aim of this study was to evaluate the short‐term effect of the HR reduction with ivabradine on N‐terminal pro‐brain natriuretic peptide ( NT‐proBNP ) in outpatients with systolic HF . Hypothesis Ivabradine improves survival and promotes left ventricle remodelling by reducing resting heart rate. Nt‐ProBNP absolute and trends predict prognosis. We hypothesized a possible association between heart rate decrease and Nt‐ProBNP values. Methods We included 25 outpatients with systolic HF on optimized medical therapy (80% on angiotensin‐converting enzyme inhibitors, 56% on spironolactone, and 88% on β‐blocker therapy), left ventricle ejection fraction <40%, and sinus rhythm and HR >70/bpm. After a 1 month running‐out period, to establish the clinical and NT‐proBNP stability, patients were started on ivabradine for 3 months. Results Ivabradine decreased NT‐proBNP ( P = 0.002) from a median of 2850 pg/ mL to 1802 pg/ mL , corresponding to a median absolute and percent decrease of 964 pg/ mL and 44.5%, respectively. The baseline HR correlated significantly with the baseline NT‐proBNP ( r s = 0.411, P = 0.041). The absolute and percent HR decrease correlated with the absolute NT‐proBNP decrease ( r s = 0.442, P = 0.027; r s = 0.395, P = 0.05). The greater the NT‐proBNP absolute decrease tertile, the greater the baseline HR ( P = 0.023) and the absolute ( P = 0.028) and percent ( P = 0.064) HR variation. Conclusions In outpatients with systolic HF , the NT‐proBNP reduction obtained by short‐term ivabradine treatment correlates closely with the degree of HR reduction.