The Efficacy Of Ivabradine In The Treatment Of Dilated Cardiomyopathy: A Meta-analysis

Objectives:Aim to systematically evaluate the efficacy of ivabradine(IVA)in combination with conventional therapy in the treatment of dilated cardiomyopathy.Methods : A systematic electronic literature search for RCTs of ivabradine(IVA)versus conventional therapy in dilated cardiomyopathy patients was performed in Pub Med,Embase,Cochrane Library,CNKI,CBM,VIP,Wanfang and other databases.The time limit of retrieval is from the establishment of the database to February 2020.Two investigators independently read the literature,and finally screened out the literature that met the inclusion criteria of this study.After extracting relevant literature and evaluating the risk of bias in the included studies,we use Rev Man 5.3for meta-analysis.Results:A total of 5 RCTs involving 339 cases of New York Heart Association class ≥ II,left ventricular ejection fraction(LVEF)≤ 40% of the patients with DCM were included.The results showed that compared with the control group,IVA group could decrease heart rate(HR)[MD=-9.04,95%CI=-11.74-6.34,P<0.001] and brain natriuretic peptide(BNP)[MD=-0.79,95%CI=-1.08～-0.49,P<0.001].IVA group was superior in 6-minute walk test(6MWT)[MD=55.97,95%CI=42.20-69.74,P<0.001],NYHA cardiac function grade [MD=-0.41,95%CI=-0.52-0.29,P<0.001],left ventricular ejection fraction(LVEF)[MD=2.08,95%CI(0.98-3.18,P<0.001],left ventricular end-diastolic diameter(LVEDD)[SMD=-1.07,95%CI=-1.50-0.65,P<0.001] and Left ventricular end-systolic diameter(LVESD)[MD=-1.65,95%CI(-2.42 to-0.89,P<0.001].Conclusion:Current evidence suggests that ivabradine combined with traditional therapy can significantly reduce the ventricular rate,alleviate the symptoms of heart failure,and effectively improve the structural remodeling and dysfunction of the heart in patients with dilated cardiomyopathy,which may be a new and effective clinical treatment strategy for patients with dilated cardiomyopathy.Due to the limitation of the number of included studies,the size of included samples and the bias of included studies,more large-scale RCT studies are needed for verification.