Effect of selective heart rate slowing in heart failure with preserved ejection fraction

Nikhil Pal, Nadiya Sivaswamy, Masliza Mahmod, Arash Yavari, Amelia Rudd, Satnam Singh, Dana K. Dawson, Jane M. Francis, Jeremy S. Dwight, Hugh Watkins, Stefan Neubauer, Michael Frenneaux, Houman Ashrafian

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

Background-Heart failure with preserved ejection fraction (HFpEF) is associated with significant morbidity and mortality but is currently refractory to therapy. Despite limited evidence, heart rate reduction has been advocated, on the basis of physiological considerations, as a therapeutic strategy in HFpEF. We tested the hypothesis that heart rate reduction improves exercise capacity in HFpEF. Methods and Results.We conducted a randomized, crossover study comparing selective heart rate reduction with the If blocker ivabradine at 7.5 mg twice daily versus placebo for 2 weeks each in 22 symptomatic patients with HFpEF who had objective evidence of exercise limitation (peak oxygen consumption at maximal exercise [Vo2 peak] 2 peak. Secondary outcomes included tissue Doppler-derived E/e' at echocardiography, plasma brain natriuretic peptide, and quality-of-life scores. Ivabradine significantly reduced peak heart rate compared with placebo in the HFpEF (107 versus 129 bpm; P2 peak in the HFpEF cohort (-2.1 versus 0.9 mL.kg-1.min-1; P=0.003) and significantly reduced submaximal exercise capacity, as determined by the oxygen uptake efficiency slope. No significant effects on the secondary end points were discernable. Conclusion.Our observations bring into question the value of heart rate reduction with ivabradine for improving symptoms in a HFpEF population characterized by exercise limitation.

Original languageEnglish
Pages (from-to)1719-1725
Number of pages7
JournalCirculation
Volume132
Issue number18
DOIs
Publication statusPublished - 3 Nov 2015
Externally publishedYes

Fingerprint

ivabradine
Heart Failure
Heart Rate
Exercise
Placebos
Brain Natriuretic Peptide
Oxygen Consumption
Cross-Over Studies
Echocardiography
Quality of Life
Oxygen
Morbidity
Mortality
Therapeutics
Population

Keywords

  • Exercise
  • Heart failure
  • Heart rate

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Pal, N., Sivaswamy, N., Mahmod, M., Yavari, A., Rudd, A., Singh, S., ... Ashrafian, H. (2015). Effect of selective heart rate slowing in heart failure with preserved ejection fraction. Circulation, 132(18), 1719-1725. https://doi.org/10.1161/CIRCULATIONAHA.115.017119

Effect of selective heart rate slowing in heart failure with preserved ejection fraction. / Pal, Nikhil; Sivaswamy, Nadiya; Mahmod, Masliza; Yavari, Arash; Rudd, Amelia; Singh, Satnam; Dawson, Dana K.; Francis, Jane M.; Dwight, Jeremy S.; Watkins, Hugh; Neubauer, Stefan; Frenneaux, Michael; Ashrafian, Houman.

In: Circulation, Vol. 132, No. 18, 03.11.2015, p. 1719-1725.

Research output: Contribution to journalArticle

Pal, N, Sivaswamy, N, Mahmod, M, Yavari, A, Rudd, A, Singh, S, Dawson, DK, Francis, JM, Dwight, JS, Watkins, H, Neubauer, S, Frenneaux, M & Ashrafian, H 2015, 'Effect of selective heart rate slowing in heart failure with preserved ejection fraction', Circulation, vol. 132, no. 18, pp. 1719-1725. https://doi.org/10.1161/CIRCULATIONAHA.115.017119
Pal, Nikhil ; Sivaswamy, Nadiya ; Mahmod, Masliza ; Yavari, Arash ; Rudd, Amelia ; Singh, Satnam ; Dawson, Dana K. ; Francis, Jane M. ; Dwight, Jeremy S. ; Watkins, Hugh ; Neubauer, Stefan ; Frenneaux, Michael ; Ashrafian, Houman. / Effect of selective heart rate slowing in heart failure with preserved ejection fraction. In: Circulation. 2015 ; Vol. 132, No. 18. pp. 1719-1725.
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