The Effect Of Ivabradine On Cardiac Function And Cardiac Echocardiographic Parameters In Patients With Dilated Cardiomyopathy

Objective:The aim of the present study was to evaluate the advantages of ivabradine combined with traditional medical therapy in improving echocardiographic parameters of heart failure in patients with dilated cardiomyopathy;The main objective of this study was also to evaluate the advantages of ivabradine combined with traditional medical therapy in improving echocardiographic parameters of heart failure in patients with dilated cardiomyopathy.Methods:From January 2018 to January 2019,60 patients diagnosed with dilated cardiomyopathy combined with moderate to severe chronic heart failure were selected from the the yanbian university hospital,and they all satisfied the enrollment conditions.Using computer random grouping scheme,the patients divided into control group(30 cases)and ivabradine group(30 cases).The control group received traditional anti-heart failure drug therapy and the ivabradine group further received oral administration of ivabradine on the basis of traditional anti-heart failure drug therapy.The initial dose of ivabradine was 5 mg,taken orally twice per day.Beta blockers and ivabradine are gradually increased over the next two to four weeks,It depending on the patient's heart rate and whether the optimal dose has reached the maximum dose mentioned above.However,the maximum dose of ivabradine is determined by the resting heart rate less than 70 beats per minute.Results:There was no significant difference between the two groups in the measurement of cardiac function at the time of enrollment.In addition,there was no significant difference in general characteristics(including heart rate and systolic blood pressure)between the two groups.However,the left ventricular ejection fraction(36.73±3.65%vs 34.51±3.67%,p=0.022)was significantly lower in the ivabradine group compared with the control group.At the end of 3 months of follow-up,the NYHA,6MWT,MLWHFscore,NT-proBNP and other indicators were improved in both groups,but the improvement of cardiac function in the ivabradine group were more effective.In the ivabradine group,left ventricular volume and inner diameter of the left ventricle were significantly reduced,and left ventricular ejection fraction,left ventricular global strain,MPI and other parameters were also significantly improved.Left ventricular wall mean stress index and left ventricular work were improved,but there were no significant difference between the two groups.At the end of 6 months of follow-up,the efficacy of ivabradine was maintained.There was no significant difference in blood pressure.However,the decrement of heart rate was significantly effective in the iavabradine group compared with the control group.The proportion of the resting HR less than 70 bpm in the two groups was 96.3%and 25.9%,respectively.At the end of 6 months of follow-up,the cardiac function and echocardiographic parameters were compared in the patients with heart rate<70 beats per minute and>70 beats per minute.The results showed the cardiac function was more significantly improved in patients with heart rate<70 beats per minute group compared with heart rate>70 beats per minute group.Patients with heart rate<70 beats per minute group had more significant redctions of left ventricular volume and left ventricular inner diameter.Left ventricular ejection fraction,left ventricular global strain,MPI and other parameters were also significantly improved in patients with heart rate<70 beats per minute group.The LV wall mean stress index and LV work were improved in patients with heart rate<70 beats per minute group,however,there was no significant difference between the two groups.These favorable parameters also implied that a redction of hospitalization rate for patients with heart rate<70 beats per minute(1.63 ± 0.51 vs2.25 ± 0.46,p<0.001).Conclusions:1.Oral ivabradine administration for dilated cardiomyopathy and symptomatic heart failure patients,not only can improve the clinical symptoms,quality of life,NT-proBNP level.but also can be improved echocardiography can be measured to evaluate the left ventricular systolic and diastolic function of various parameters.2.The application of ivabradine can increase the ejection fraction of the left ventricle and improve the echocardiographic parameters associated with the left ventricular global strain,MPI and other responses to cardiac function.3.The improvement of cardiac function indicators and echocardiographic parameters in iavabradine group maybe benefited from more effective decrement of heart rate.