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01-03-2021 | Stroke

Hemodynamic effects of ivabradine use in combination with intravenous inotropic therapy in advanced heart failure

Authors: Mohammed Elzeneini, Juan M. Aranda Jr, Mohammad Al-Ani, Mustafa M. Ahmed, Alex M. Parker, Juan R. Vilaro

Published in: Heart Failure Reviews | Issue 2/2021

Abstract

Intravenous inotropic therapy can be used in patients with advanced heart failure, as palliative therapy or as a bridge to cardiac transplantation or mechanical circulatory support, as well as in cardiogenic shock. Their use is limited to increasing cardiac output in low cardiac output states and reducing ventricular filling pressures to alleviate patient symptoms and improve functional class. Many advanced heart failure patients have sinus tachycardia as a compensatory mechanism to maintain cardiac output. However, excessive sinus tachycardia caused by intravenous inotropes can increase myocardial oxygen consumption, decrease coronary perfusion, and at extreme heart rates decrease ventricular filling and stroke volume. The limited available hemodynamic studies support the hypothesis that adding ivabradine, a rate control agent without negative inotropic effect, may blunt inotrope-induced tachycardia and its associated deleterious effects, while optimizing cardiac output by increasing stroke volume. This review analyzes the intriguing pathophysiology of combined intravenous inotropes and ivabradine to optimize the hemodynamic profile of patients in advanced heart failure.

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Title: Hemodynamic effects of ivabradine use in combination with intravenous inotropic therapy in advanced heart failure
Authors: Mohammed Elzeneini
Juan M. Aranda Jr
Mohammad Al-Ani
Mustafa M. Ahmed
Alex M. Parker
Juan R. Vilaro
Publication date: 01-03-2021
Publisher: Springer US
Keywords: Stroke
Tachyarrythmia
Ivabradine
Cardiogenic Shock
Cardiogenic Shock
Heart Failure
Milrinone
Published in: Heart Failure Reviews / Issue 2/2021
Print ISSN: 1382-4147
Electronic ISSN: 1573-7322
DOI: https://doi.org/10.1007/s10741-020-10029-x

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