Ivabradine in chronic stable angina: Effects by and beyond heart rate reduction

被引：37

作者：

Camici, Paolo G. ^{[1
]}

Gloekler, Steffen ^{[2
]}

Levy, Bernard I. ^{[3
]}

Skalidis, Emmanouil ^{[4
]}

Tagliamonte, Ercole ^{[5
]}

Vardas, Panos ^{[6
]}

Heusch, Gerd ^{[7
]}

机构：

[1] Univ Vita Salute San Raffaele, Hosp San Raffaele, Milan, Italy

[2] Univ Hosp Bern, Cardiovasc Dept, Cardiol, CH-3010 Bern, Switzerland

[3] Hop Lariboisiere, INSERM, PARCC, U970,Vessels & Blood Inst, F-75475 Paris, France

[4] Univ Hosp Herakl, Dept Cardiol, Iraklion, Greece

[5] Umberto I Hosp, Div Cardiol, Nocera Inferiore, SA, Italy

[6] Univ Hosp Herakl, Dept Cardiol, Iraklion, Greece

[7] Univ Essen Gesamthsch, West German Heart & Vasc Ctr Essen, Inst Pathophysiol, Sch Med, D-45122 Essen, Germany

来源：

INTERNATIONAL JOURNAL OF CARDIOLOGY | 2016年 / 215卷

关键词：

Angina pectoris; Anti-anginal drug; Beta-blocker; Coronary artery disease; Coronary blood flow; Coronary collateral circulation; CORONARY-ARTERY-DISEASE; INDUCED MYOCARDIAL-ISCHEMIA; FLOW VELOCITY; BLOOD-FLOW; COLLATERAL VESSELS; DYSFUNCTION; PERFUSION; PATHOPHYSIOLOGY; DETERMINANTS; BRADYCARDIA;

D O I：

10.1016/j.ijcard.2016.04.001

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Heart rate plays a major role in myocardial ischemia. A high heart rate increases myocardial performance and oxygen demand and reduces diastolic time. Ivabradine reduces heart rate by inhibiting the If current of sinoatrial-node cells. In contrast to beta-blockers, ivabradine has no negative inotropic and lusitropic effect for a comparable heart rate reduction. Consequently, diastolic duration is increased with ivabradine compared to beta-blockers. This has potential consequences on coronary blood flow since compression of the vasculature by the surrounding myocardium during systole impedes flow and coronary blood flow is mainly diastolic. Moreover, ivabradine does not unmask alpha-adrenergic vasoconstriction and, unlike beta-blockers, maintains coronary dilation during exercise. In comparison with beta-blockers, ivabradine increases coronary flow reserve and collateral perfusion promoting the development of coronary collaterals. Ivabradine attenuates myocardial ischemia and its consequences even in the absence of heart rate reduction, possibly through reduced formation of reactive oxygen species. In conclusion, ivabradine differs from other anti-anginal agents by improving coronary blood flow and by additional pleiotropic effects. These properties make ivabradine an effective anti- anginal and anti- ischemic agent for the treatment of patients with coronary artery disease. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

引用

页码：1 / 6

页数：6

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