This review article is devoted to the treatment of chronic
heart failure (HF) with a new generation
drug -
ivabradine. It is well known that HF is one of the most frequent reason of high mortality worldwide. HF is characterised by cardiac remodeling, which is central in the pathophysiology of HF including hemodynamic, neurohumoral and neurohormonal mechanisms during its development and established prognostic factor in patients suffered with this disease. Despite the introduction in medical practice of many drugs for the treatment of chronic HF the lethal outcome associated with HF remains high nowadays, which can be explained by complexity of remodeling mechanisms characteristic for development of HF.
Ivabradine that has been introduced in medical practice in last decade is a pure heart rate-slowing agent. A large number of studies in patients with
cardiovascular disease have demonstrated that heart rate (HR) is a very important and major independent risk factor for prognosis, because lowering of HR reduces cardiac work and diminished myocardial
oxygen requirement. It was shown that
ivabradine a selective inhibitor of the hyperpolarisation activated
sodium chanel (If) is involved in pacemaker generation and responsiveness of the sino-atrial node resulting in HR reduction without negative inotropic action.
Ivabradine in chronic HF improves diastolic function and attenuates cardiac tissue
hypoxia. Long-term reduction of HR induced by
ivabradine reduced remodeling and preserved
nitric oxide (NO) bioavailability, resulting from processes triggered early after reduction of HR. The complex
therapy including
ivabradine promotes HR fall, leading in reduction of attacks of a
stable angina and improved quality of life.
Ivabradine may target the endothelial NO production via inhibition of
protein tyrosine phosphatase 1B leading to endothelial protection. HR reduction by
ivabradine reduces oxidative stress, improves endothelial function and prevents development of atherosclerostic changes in
apolipoprotein E-deficient mice. In multicenter clinical trials it has been proved that
ivabradine is superior to beta-blocking agents during complex
therapy of chronic HF accompanied with its beneficial effects related to cardiac remodeling, improvement of the currency of HF and diminution of patients rehospitalisation. It is suggested that
ivabradine as a newer agent is a valuable perspective
drug for the treatment of congestive HF.