If Channel Blockade With Ivabradine in Patients With Diastolic Heart Failure
St Vincent's University Hospital, Ireland
The purpose of this study is to investigate whether the medicine ivabradine, a novel drug
which slows the heart rate has a favourable effect on patients with diastolic heart failure.
Ivabradine is a specific heart rate-lowering agent. It has a licence for treating patients
with angina who are intolerant of agents such as beta blockers or whose angina is not
adequately controlled. It has been shown to prolong exercise tolerance in these patients and
to reduce the frequency of chest pain. Its mechanism of action is felt to be purely due to
reducing heart rate, by as much as 10 beats per minute at rest, as well as by reducing the
heart rate response to exercise.
Patients with diastolic heart failure often complain of breathlessness on exertion which
relates to the stiffness or lack of compliance of their heart i.e. the heart fails to relax
rapidly enough to allow it to fill with blood between each heart beat. This may result in
high pressure in the heart chamber which backs up in to the lungs and may be experienced as
breathlessness. There is little evidence that any specific therapy benefits patients with
this type of heart failure besides treating coexisting problems such as high blood pressure
or angina. By slowing the heart rate down with ivabradine, the heart would have a longer
time to fill during exercise which would make it more effective. This slowing of the heart
rate may therefore relieve the breathlessness experienced on activity such as walking to the
shops or up a flight of stairs etc.
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