Effect of ivabradine on left ventricular remodelling after reperfused myocardial infarction: a pilot study

Purpose: To evaluate whether ivabradine, when added to current guideline-based therapy, improves Left Ventricular (LV) remodelling in STEMI patients treated with successful PPCI. Methods: This case-control study included sixty-two patients, between June 2011 and July 2012 (the ivabradine group). Ivabradine, at the dose of 5 mg twice daily, was given promptly after PPCI, along with beta-blockers, to obtain HR <60 b.p.m. This group was matched with STEMI patients according to age, sex, infarct-related coronary artery, ischemia time and infarct size, determined by initial CMR (the control group). Six patients in the ivabradine group were excluded from the final analysis. Follow-up CMR data at 3 months were available for 112 patients. Results: The HR showed a significant reduction between 1 hour after angioplasty and 3 months of treatment in both groups (76.8±7.3 vs 54.7±5.8 and 71.5±11.9 vs 57.7±6.8 b.p.m, respectively, p<0.001). Furthermore HR in the ivabradine group was lower than the control group during initial CMR (56.3±5.0 vs 58.9±6.2 b.p.m, p=0.04). This difference increased during follow-up CMR (54.7±5.8 vs 57.7±6.8 b.p.m, p=0.02). Infarct sizes were similar between both groups. At follow-up CMR, treatment with ivabradine was associated with a smaller increase in LVEDV index (75.0±19.1 vs 72.6±15.1 ml/m2) vs control group (78.7±17.3 vs 72.8±15.5 ml/m2) (p=0.04). In the ivabradine group LVESV index remained unchanged (31.0±14.7 vs 30.9±11.2 ml/m2), whereas in the control group LVESV index increased (35.5±14.3 vs 32.5±10.4 ml/m2) (p=0.04). There was a nonsignificant trend toward greater improvement of LVEF in the ivabradine group (60.1±10.1 vs 58.1±9.8%) versus the control group (56.3±11.0 vs 56.4±9.2%) (p=0.09). Conclusions: In successful reperfused STEMI patients, ivabradine improves LV remodelling when added to current guideline-based therapy including beta-blockers. Given these promising results, larger studies are necessary to confirm our findings