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Heart rate as a prognostic marker and therapeutic target in acute and chronic heart failure.
Journal article

Heart rate as a prognostic marker and therapeutic target in acute and chronic heart failure.

  • Oliva F ASST Grande Ospedale Metropolitano Niguarda, De Gasperis Cardio Center, Milano, Italy. Electronic address: fabrizio.oliva@ospedaleniguarda.it.
  • Sormani P ASST Grande Ospedale Metropolitano Niguarda, De Gasperis Cardio Center, Milano, Italy.
  • Contri R Anestesia e Cure Intense, Cardiocentro Ticino, Lugano, Switzerland.
  • Campana C Dipartimento di Cardiologia, A.O. Sant'Anna, Como, Italy.
  • Carubelli V Cardiologia, c/o Spedali Civili di Brescia, Università di Brescia, Brescia, Italy.
  • Cirò A Unità scompenso cardiaco, Dipartimento Cardio-Toraco-Vascolare, Ospedale San Gerardo, Monza, Italy.
  • Morandi F Cardiologia, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
  • Di Tano G U.O. Cardiologia, Ospedale-ASST di Cremona, Cremona, Italy.
  • Mortara A Dipartimento di Cardiologia e Unità Scompenso, Policlinico di Monza, Monza, Italy.
  • Senni M Dipartimento Cardiovascolare, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
  • Metra M Cardiologia, c/o Spedali Civili di Brescia, Università di Brescia, Brescia, Italy.
  • Ammirati E ASST Grande Ospedale Metropolitano Niguarda, De Gasperis Cardio Center, Milano, Italy. Electronic address: enrico.ammirati@ospedaleniguarda.it.
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  • 2017-12-19
Published in:
  • International journal of cardiology. - 2018
Acute heart failure
Atrial fibrillation
Beta-blockers
Heart rate
Ivabradine
Sinus rhythm
Acute Disease
Cardiotonic Agents
Chronic Disease
Clinical Trials as Topic
Heart Failure
Heart Rate
Humans
Prognosis
Registries
Stroke Volume
English Since increased heart rate (HR) is associated with higher mortality in several cardiac disorders, HR is considered not only a physiological indicator but also a prognostic and biological marker. In heart failure (HF), it represents a therapeutic target in chronic phase. The use or up-titration of beta-blockers, a milestone in HF with reduced left ventricular ejection fraction (LVEF) treatment, is at times limited by patients' hemodynamic profile or intolerance. Ivabradine, a HR-lowering drug inhibiting the f-current in pacemaker cells, has been shown to improve outcome in patients with chronic HF, in sinus rhythm with increased HR beyond beta-blocker therapy. The rationale for this review is to update the role of HR as a prognostic biomarker and a potential therapeutic target in other scenarios than chronic HF; namely, in patients with coexisting atrial fibrillation (AF), in HF with preserved LVEF (HFpEF), in acute HF, and in patients discharged after an episode of acute HF. Preliminary studies and case reports that evaluated the use of ivabradine in the setting of acute HF will be summarized. Recent results of HR reduction in the setting of HFpEF with ivabradine will be presented. Finally, data from large registries and trials that evaluated the prognostic impact of HR in patients with acute HF and sinus rhythm or AF will be reviewed, showing that only patients in sinus rhythm may benefit from HR reduction.
Language
  • English
Open access status
closed
Identifiers
Persistent URL
https://sonar.ch/global/documents/279276
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