PMID- 31308326
OWN - NLM
STAT- MEDLINE
DCOM- 20190805
LR  - 20190805
IS  - 1349-3299 (Electronic)
IS  - 1349-2365 (Linking)
VI  - 60
IP  - 4
DP  - 2019 Jul 27
TI  - Ivabradine Improves Cardiac Function and Increases Exercise Capacity in Patients 
      with Chronic Heart Failure.
PG  - 899-909
LID - 10.1536/ihj.18-559 [doi]
AB  - To systematically review and conduct a meta-analysis of the ivabradine-induced 
      improvement in cardiopulmonary function, exercise capacity, and primary composite 
      endpoints in patients with chronic heart failure (CHF).This study was a 
      systematic review and meta-analysis.Databases, including PubMed, Embase, Cochrane 
      Central Register of Controlled Trials (CENTRAL), and Clinical Trials and European 
      Union Clinical Trials, were searched for randomized placebo-controlled trials. 
      The efficacy and safety of ivabradine treatment in patients with CHF were 
      assessed and compared to those of the standard anti-heart failure treatment. 
      Review Manager 5.3 software was used to analyze the relative risk (RR) for 
      dichotomous data and the mean difference (MD) for continuous data.In total, 22 
      studies with 24,562 patients were included. Cardiopulmonary function analysis 
      showed that treatment with added ivabradine reduced the heart rate (MD = -17.30, 
      95% confidence interval (CI): 19.52--15.08, P < 0.00001), significantly increased 
      the left ventricular ejection fraction (LVEF) (MD = 3.90, 95% CI: 0.40-7.40, P < 
      0.0001), and led to a better New York Heart Association (NYHA) classification. 
      Ivabradine significantly reduced the minute ventilation/carbon dioxide production 
      (VE/VCO(2)) (MD = -2.68, 95% CI: -4.81--0.55, P = 0.01) and improved the peak 
      VO(2) (MD = 2.80, 95% CI: 1.05-4.55, P = 0.002) and the exercise capacity, 
      including the exercise duration with a submaximal load (MD = 7.82, 95% CI: 
      -2.57--18.21, P < 0.00001) and the 6-minute walk distance. The RR of 
      cardiovascular death or worsening heart failure was significantly decreased (RR = 
      0.93, 95% CI: 0.87--0.98, P = 0.01) in the patients treated with ivabradine. 
      Additionally, the RRs of heart failure and hospitalization also decreased (RR = 
      0.91, 95% CI: 0.85--0.97, P = 0.006; RR = 0.86, 95% CI: 0.79--0.93, P = 0.0002). 
      Safety analysis showed no significant difference in the RR of severe adverse 
      events between the ivabradine group and the standard anti-heart failure treatment 
      group (P = 0.40). However, ivabradine significantly increased the RR of visual 
      symptoms in CHF patients (RR = 3.82, 95% CI: 1.80--8.13, P = 0.0005).Existing 
      evidence showed that adding ivabradine treatment significantly improved the 
      cardiopulmonary function and increased the exercise capacity of patients with 
      CHF. Adding ivabradine to the standard anti-heart failure treatment reduced the 
      mortality and hospitalization risk and improved the quality of life. Finally, 
      ivabradine significantly increased the RR of visual symptoms in CHF patients.This 
      is the first systematic review and meta-analysis to focus on the efficacy of 
      ivabradine, which improved the cardiac function and increased the exercise 
      capacity in patients with chronic heart failure (CHF). Therefore, this study will 
      help evaluate the quality of life after adding ivabradine to the treatment of 
      patients with CHF, even though there are differences in the standard for resting 
      heart rate, left ventricular ejection fraction (LVEF), and New York Heart 
      Association (NYHA) class in the included studies. This hybrid effect might be 
      smaller when analyzed separately but might have a higher heterogeneity when 
      analyzed in multiple studies.
FAU - Pei, Hui
AU  - Pei H
AD  - Department of Cardiology, Jinan Central Hospital Affiliated with Shandong 
      University.
AD  - Ti'an City Central Hospital.
FAU - Miao, Wei
AU  - Miao W
AD  - Department of Cardiology, Jinan Central Hospital Affiliated with Shandong 
      University.
FAU - Xie, Wen-Zhi
AU  - Xie WZ
AD  - Department of Cardiology, Jinan Central Hospital Affiliated with Shandong 
      University.
FAU - Wang, Wei
AU  - Wang W
AD  - Department of Cardiology, Shandong Provincial Chest Hospital.
FAU - Zhao, Di
AU  - Zhao D
AD  - Department of Cardiology, Affiliated Hospital of Shandong Academy of Medical 
      Sciences.
FAU - Su, Guo-Hai
AU  - Su GH
AD  - Department of Cardiology, Jinan Central Hospital Affiliated with Shandong 
      University.
FAU - Zhao, Zhuo
AU  - Zhao Z
AD  - Department of Cardiology, Jinan Central Hospital Affiliated with Shandong 
      University.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20190712
PL  - Japan
TA  - Int Heart J
JT  - International heart journal
JID - 101244240
RN  - 0 (Cardiovascular Agents)
RN  - 3H48L0LPZQ (Ivabradine)
SB  - IM
MH  - Cardiovascular Agents/therapeutic use
MH  - Exercise Tolerance/*drug effects
MH  - Heart Failure/*drug therapy/physiopathology
MH  - Humans
MH  - Ivabradine/*therapeutic use
MH  - Stroke Volume/drug effects/*physiology
MH  - Ventricular Function, Left/drug effects/*physiology
OTO - NOTNLM
OT  - Heart rate
OT  - Left ventricular ejection fraction
OT  - Lung function
OT  - Peak VO2
EDAT- 2019/07/17 06:00
MHDA- 2019/08/06 06:00
CRDT- 2019/07/17 06:00
PHST- 2019/07/17 06:00 [pubmed]
PHST- 2019/08/06 06:00 [medline]
PHST- 2019/07/17 06:00 [entrez]
AID - 10.1536/ihj.18-559 [doi]
PST - ppublish
SO  - Int Heart J. 2019 Jul 27;60(4):899-909. doi: 10.1536/ihj.18-559. Epub 2019 Jul 
      12.