Published in:
01-12-2011 | Editorial
Beta-Blocker Dose Up-Titration or Addition of Ivabradine in Stable Angina: More is Not Necessarily Better
Editorial to: “Efficacy of Ivabradine in Combination with Beta-Blocker Versus Uptitration of Beta-Blocker in Patients with Stable Angina” by E. Amosova et al.
Authors:
Raymond W. Sy, Saul B. Freedman
Published in:
Cardiovascular Drugs and Therapy
|
Issue 6/2011
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Excerpt
The main action of ivabradine is to reduce heart rate through selective I
f-current blockade [
1]. The I
f-current is the major determinant of diastolic depolarization in the sinoatrial node and, and hence I
f-current dictates the intrinsic pacemaker rate during rest and exercise [
2]. Reduction in heart rate is desirable in conditions such as coronary artery disease and congestive heart failure because it increases diastolic time and so improves coronary blood flow and left ventricular filling while reducing cardiac work and myocardial oxygen consumption [
3]. Hence, it is not surprising that ivabradine has been demonstrated to improve anginal symptoms and exercise performance in patients with coronary artery disease [
4]. In addition, ivabradine reduces heart failure-related deaths and hospitalizations in patients with symptomatic heart failure [
5], and may reduce infarction and the need for revascularization in patients with coronary artery disease and left ventricular dysfunction [
6]. Compared to other agents that attenuate heart rate such as beta-blockers and non-dihydropyridine calcium channel blockers, ivabradine has the potential advantage of being heart-rate specific with minimal impact on inotropy, dromotropy and coronary vasomotion. …
