2023 Feb;24(2):113-122. doi: 10.2459/JCM.0000000000001427.
Mortara Andrea, Rossi Jessica, Mazzetti Simone, Catagnano Francesco, Cavalotti Cristina, Malerba Gianluigi, Vecchio Chiara, Morandi Fabrizio, Nassiacos Daniele, Oliva Fabrizio
Abstract
BACKGROUND: In patients admitted for acute heart failure (HF) indication for drugs which reduce the heart rate (HR) is debated. The multicentre prospective study Reduction of heart Rate in Heart Failure (RedRate-HF) was designed to analyse the hemodynamic effects of an early reduction of HR in acute HF.
METHODS: Hemodynamic parameters were recorded by using the bioimpedance technique, which was shown to be accurate, highly reproducible and sensitive to intra-observer changes. Lowering HR was obtained by ivabradine 5?mg bd, given 48-72?h after admission on the top of optimized treatment. Patients were followed at 24, 48, 72?h after drug assumption and at hospital discharge.
RESULTS: Twenty patients of a mean age of 67?±?15 years, BNP at entry 1348?±?1198?pg/ml were enrolled. Despite a clinical stabilization, after 48-72?h from admission, HR was persistently >70?bpm. Ivabradine was well tolerated in all patients with a significant increase in RR interval from 747?±?69?ms at baseline to 948?±?121 ms at discharge, P?0.0001. Change in HR was associated with a significant increase in stroke volume (baseline 73?±?22 vs. 84?±?19?ml at discharge, P?=?0.03), and reduction in left cardiac work index (baseline 3.6?±?1.2 vs. 3.1?±?1.1?kg/m2 at discharge, P?=?0.04). Other measures of heart work were also significantly affected while cardiac output remained unchanged.
CONCLUSION: The strategy of an early lowering of HR in patients admitted for acute HF on top of usual care is feasible and safe. The HR reduction causes a positive increase in stroke volume and may contribute to saving energy without affecting cardiac output.
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