Control of Sinus Node Tachycardia as an Additional Therapy in Patients With Decompensated Heart Failure
- Registration Number
- NCT02236247
- Lead Sponsor
- University of Sao Paulo
- Brief Summary
Study aims to compare the I(f) inhibitor ivabradine with placebo as strategy of heart rate control in patients with decompensated heart failure (DHF).
- Detailed Description
Sympathetic hyperactivity and consequent increase in heart rate (HR) are physiological responses to low cardiac output in patients with decompensated heart failure (DHF). However, elevated HR may become inappropriate in these patients, increasing myocardial oxygen demand and decreasing diastolic filling time and might lead to hemodynamic deterioration, ventricular dysfunction (tachycardiomyopathy) and clinical deterioration.
Studies show the elevated HR is a predictor of poor prognosis in DHF. Subanalyses of large clinical trials using beta blockers (BBs) demonstrate the adequate control of HR correlates with a better outcome in patients with stable chronic heart failure (HF). However, use of BBs in patients with DHF is limited due to negative inotropic and hypotensive effects of these drugs.
As alternative to BBs, ivabradine has shown to increase survival of patients with chronic stable systolic HF. Compared to BBs, ivabradine has the advantage of "pure" negative chronotropic effect, no effect on myocardial contractility or peripheral vascular resistance. Despite the inhibition of I (f) has been validated as a therapeutic option in patients with stable HF, there are no studies available on this strategy in patients with DHF.
We hypothesized that HR control by ivabradine might improve clinical, hemodynamic and neurohormonal parameters in patients with DHF. The aim of this study was to evaluate the efficacy of HR control with ivabradine in patients with DHF.
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 50
- Sinus node rhythm
- HR> 80 bpm
- Hospitalization for DHF
- Ejection fraction ≤ 40%
- Sign informed consent
- Systolic blood pressure <85 mmHg
- Signs of hypoperfusion
- Dobutamine>15 mcg/Kg/min
- Acute myocarditis
- Primary valvular disease requiring surgery
- Stroke in the last three months
- Hypertrophic or restrictive cardiomyopathy
- Sinus node disease
- Atrial fibrillation or flutter
- Second or third degree atrio-ventricular blockade
- Long QT syndrome
- Severe pulmonary disease
- Pulmonary embolism in the last three months
- Need for invasive ventilatory support
- Septicemia or septic shock
- Hepatic failure
- Creatinine > 2.5 mg/dL
- Hemodialysis
- Advanced malignancy
- Pregnancy or lactation
- Immunosuppressive therapy
- Use of cytochrome P450 inhibitors
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description placebo Placebo placebo pill will be administered orally twice daily ivabradine ivabradine I(f) inhibitor, heart rate controller
- Primary Outcome Measures
Name Time Method Change from baseline heart rate Baseline, day 5 after intervention Heart rate will be assessed at morning, after 30 minutes of rest, recorded by electrocardiogram.
- Secondary Outcome Measures
Name Time Method Change from baseline blood pressure Baseline, day 5 after intervention Blood pressure will be measured at morning by electronic cuff
Change from baseline ejection fraction Baseline, day 5 after intervention Ejection fraction will be measured by echocardiography using Simpson´s rule
Change from baseline stroke volume Baseline, day 5 after intervention Stroke volume will be measured by echocardiography using Doppler velocity-time integral technique.
Change from baseline creatinine Baseline, day 5 after intervention Serum creatinine will be measured
Change from baseline brain natriuretic peptide Baseline, day 5 after intervention Serum brain natriuretic peptide will be measured
Clinical Up to 6 months Time of survival and free of readmission
Trial Locations
- Locations (1)
Heart Failure Unit, Heart Institute, University of Sao Paulo Medical School
🇧🇷Sao Paulo, Brazil