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Baka T, Repova K, Luptak I, Simko F. Ivabradine in the management of COVID-19-related cardiovascular complications: A perspective. Curr Pharm Des 2022; 28:1581-1588. [DOI: 10.2174/1381612828666220328114236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/02/2022] [Indexed: 11/22/2022]
Abstract
Abstract:
Besides acute respiratory distress syndrome, acute cardiac injury is a major complication in severe coronavirus disease 2019 (COVID-19) and associates with a poor clinical outcome. Acute cardiac injury with COVID-19 can be of various etiologies, including myocardial ischemia or infarction and myocarditis, and may compromise cardiac function, resulting in acute heart failure or cardiogenic shock. Systemic inflammatory response increases heart rate (HR), which disrupts the myocardial oxygen supply/demand balance and worsens cardiac energy efficiency, thus further deteriorating the cardiac performance of the injured myocardium. In fact, the combination of elevated resting HR and markers of inflammation synergistically predicts adverse cardiovascular prognosis. Thus, targeted HR reduction may potentially be of benefit in cardiovascular pathologies associated with COVID-19. Ivabradine is a drug that selectively reduces HR via If current inhibition in the sinoatrial node without a negative effect on inotropy. Besides selective HR reduction, ivabradine was found to exert various beneficial pleiotropic effects, either HR-dependent or HR-independent, including anti-inflammatory, anti-atherosclerotic, anti-oxidant and antiproliferative actions and the attenuation of endothelial dysfunction and neurohumoral activation. Cardioprotection by ivabradine has already been indicated in cardiovascular pathologies that are prevalent with COVID-19, including myocarditis, acute coronary syndrome, cardiogenic shock or cardiac dysautonomia. Here, we suggest that ivabradine may be beneficial in the management of COVID-19-related cardiovascular complications.
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Affiliation(s)
- Tomas Baka
- Institute of Pathophysiology, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic
| | - Kristina Repova
- Institute of Pathophysiology, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic
| | - Ivan Luptak
- Cardiovascular Medicine Section, Boston University School of Medicine, Boston, MA, USA
- Myocardial Biology Unit, Boston University School of Medicine, Boston, MA, USA
| | - Fedor Simko
- Institute of Pathophysiology, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic
- Cardiovascular Medicine Section, Boston University School of Medicine, Boston, MA, USA
- Myocardial Biology Unit, Boston University School of Medicine, Boston, MA
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Ramirez-Carracedo R, Tesoro L, Hernandez I, Diez-Mata J, Botana L, Saura M, Sanmartin M, Zamorano JL, Zaragoza C. Ivabradine-Stimulated Microvesicle Release Induces Cardiac Protection against Acute Myocardial Infarction. Int J Mol Sci 2020; 21:ijms21186566. [PMID: 32911752 PMCID: PMC7555962 DOI: 10.3390/ijms21186566] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/06/2020] [Accepted: 09/07/2020] [Indexed: 12/20/2022] Open
Abstract
Ivabradine can reduce heart rate through inhibition of the current I(f) by still unexplored mechanisms. In a porcine model of ischemia reperfusion (IR), we found that treatment with 0.3 mg/kg Ivabradine increased plasma release of microvesicles (MVs) over Placebo, as detected by flow cytometry of plasma isolated from pigs 7 days after IR, in which a tenfold increase of Extracellular Matrix Metalloproteinase Inducer (EMMPRIN) containing (both high and low-glycosylated) MVs, was detected in response to Ivabradine. The source of MVs was investigated, finding a 37% decrease of CD31+ endothelial cell derived MVs, while CD41+ platelet MVs remained unchanged. By contrast, Ivabradine induced the release of HCN4+ (mostly cardiac) MVs. While no differences respect to EMMPRIN as a cargo component were found in endothelial and platelet derived MVs, Ivabradine induced a significant release of EMMPRIN+/HCN4+ MVs by day 7 after IR. To test the role of EMMPRIN+ cardiac MVs (EMCMV), H9c2 cell monolayers were incubated for 24 h with 107 EMCMVs, reducing apoptosis, and increasing 2 times cell proliferation and 1.5 times cell migration. The in vivo contribution of Ivabradine-induced plasma MVs was also tested, in which 108 MVs isolated from the plasma of pigs treated with Ivabradine or Placebo 7 days after IR, were injected in pigs under IR, finding a significant cardiac protection by increasing left ventricle ejection fraction and a significant reduction of the necrotic area. In conclusion ivabradine induces cardiac protection by increasing at least the release of EMMPRIN containing cardiac microvesicles.
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Affiliation(s)
- Rafael Ramirez-Carracedo
- Cardiology Department, Universidad Francisco de Vitoria/Hospital Ramón y Cajal Research Unit (IRYCIS), 28223 Madrid, Spain; (R.R.-C.); (L.T.); (I.H.); (J.D.-M.); (L.B.)
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.S.); (M.S.); (J.L.Z.)
| | - Laura Tesoro
- Cardiology Department, Universidad Francisco de Vitoria/Hospital Ramón y Cajal Research Unit (IRYCIS), 28223 Madrid, Spain; (R.R.-C.); (L.T.); (I.H.); (J.D.-M.); (L.B.)
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.S.); (M.S.); (J.L.Z.)
| | - Ignacio Hernandez
- Cardiology Department, Universidad Francisco de Vitoria/Hospital Ramón y Cajal Research Unit (IRYCIS), 28223 Madrid, Spain; (R.R.-C.); (L.T.); (I.H.); (J.D.-M.); (L.B.)
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.S.); (M.S.); (J.L.Z.)
| | - Javier Diez-Mata
- Cardiology Department, Universidad Francisco de Vitoria/Hospital Ramón y Cajal Research Unit (IRYCIS), 28223 Madrid, Spain; (R.R.-C.); (L.T.); (I.H.); (J.D.-M.); (L.B.)
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.S.); (M.S.); (J.L.Z.)
| | - Laura Botana
- Cardiology Department, Universidad Francisco de Vitoria/Hospital Ramón y Cajal Research Unit (IRYCIS), 28223 Madrid, Spain; (R.R.-C.); (L.T.); (I.H.); (J.D.-M.); (L.B.)
| | - Marta Saura
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.S.); (M.S.); (J.L.Z.)
- Systems Biology Department, Facultad de Medicina Universidad de Alcalá, IRYCIS, 28772 Alcala de Henares, Spain
| | - Marcelo Sanmartin
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.S.); (M.S.); (J.L.Z.)
- Cardiology Department, IRYCIS, 28034 Madrid, Spain
| | - Jose Luis Zamorano
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.S.); (M.S.); (J.L.Z.)
- Cardiology Department, IRYCIS, 28034 Madrid, Spain
| | - Carlos Zaragoza
- Cardiology Department, Universidad Francisco de Vitoria/Hospital Ramón y Cajal Research Unit (IRYCIS), 28223 Madrid, Spain; (R.R.-C.); (L.T.); (I.H.); (J.D.-M.); (L.B.)
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain; (M.S.); (M.S.); (J.L.Z.)
- Correspondence:
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Pascual Izco M, Ramírez-Carracedo R, Hernández Navarro I, Osorio Ruiz Á, Castejón Navarro B, Cuadrado Berrocal I, Largo Aramburu C, Alonso Salinas GL, Díez J, Saura Redondo M, Zamorano JL, Zaragoza C, Sanmartín M. Ivabradine in acute heart failure: Effects on heart rate and hemodynamic parameters in a randomized and controlled swine trial. Cardiol J 2018; 27:62-71. [PMID: 30155868 PMCID: PMC8086495 DOI: 10.5603/cj.a2018.0078] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 08/14/2018] [Accepted: 05/20/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Acute heart failure patients could benefit from heart rate reduction, as myocardial consumption and oxidative stress are related to tachycardia. Ivabradine could have a clinical role attenuating catecholamine-induced tachycardia. The aim of this study was to evaluate hemodynamic effects of ivabradine in a swine model of acute heart failure. METHODS Myocardial infarction was induced by 45 min left anterior descending artery balloon occlusion in 18 anesthetized pigs. An infusion of dobutamine and noradrenaline was maintained aiming to preserve adequate hemodynamic support, accompanied by fluid administration to obtain a pulmonary wedged pressure ≥ 18 mmHg. After reperfusion, rhythm and hemodynamic stabilization, the animals were randomized to 0.3 mg/kg ivabradine intravenously (n = 9) or placebo (n = 9). Hemodynamic parameters were observed over a 60 min period. RESULTS Ivabradine was associated with a significant reduction in heart rate (88.4 ± 12.0 bpm vs. 122.7 ± 17.3 bpm after 15 min of ivabradine/placebo infusion, p < 0.01) and an increase in stroke volume (68.8 ± 13.7 mL vs. 52.4 ± 11.5 mL after 15 min, p = 0.01). There were no significant differences in systemic or pulmonary arterial pressure, or significant changes in pulmonary capillary pressure. However, after 15 min, cardiac output was significantly reduced with ivabradine (-5.2% vs. +15.0% variation in ivabradine/placebo group, p = 0.03), and central venous pressure increased (+4.2% vs. -19.7% variation, p < 0.01). CONCLUSIONS Ivabradine reduces heart rate and increases stroke volume without modifying systemic or left filling pressures in a swine model of acute heart failure. However, an excessive heart rate reduction could lead to a decrease in cardiac output and an increase in right filling pressures. Future studies with specific heart rate targets are needed.
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Affiliation(s)
- Marina Pascual Izco
- Cardiology Department, Ramón y Cajal University Hospital (IRYCIS), University of Alcalá de Henares, Madrid, Spain
| | - Rafael Ramírez-Carracedo
- Cardiology Department, Cardiovascular Research Unit. Francisco de Vitoria University - Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | - Ignacio Hernández Navarro
- Cardiology Department, Cardiovascular Research Unit. Francisco de Vitoria University - Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | - Álvaro Osorio Ruiz
- Vascular Surgery Department, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | | | | | | | - Gonzalo Luis Alonso Salinas
- Cardiology Department, Ramón y Cajal University Hospital (IRYCIS), University of Alcalá de Henares, Madrid, Spain
- CIBERCV, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | - Javier Díez
- Cardiology Department, Cardiovascular Research Unit. Francisco de Vitoria University - Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | - Marta Saura Redondo
- Physiology Unit, Systems Biology Department, University of Alcalá de Henares, Madrid, Spain
| | - José Luis Zamorano
- Cardiology Department, Ramón y Cajal University Hospital (IRYCIS), University of Alcalá de Henares, Madrid, Spain
- CIBERCV, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | - Carlos Zaragoza
- Cardiology Department, Cardiovascular Research Unit. Francisco de Vitoria University - Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
- CIBERCV, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain
| | - Marcelo Sanmartín
- Cardiology Department, Ramón y Cajal University Hospital (IRYCIS), University of Alcalá de Henares, Madrid, Spain.
- CIBERCV, Ramón y Cajal University Hospital (IRYCIS), Madrid, Spain.
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Nguyen LS, Squara P, Amour J, Carbognani D, Bouabdallah K, Thierry S, Apert-Verneuil C, Moyne A, Cholley B. Intravenous ivabradine versus placebo in patients with low cardiac output syndrome treated by dobutamine after elective coronary artery bypass surgery: a phase 2 exploratory randomized controlled trial. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:193. [PMID: 30115103 PMCID: PMC6097391 DOI: 10.1186/s13054-018-2124-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 07/10/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Low cardiac output syndrome (LCOS) is a severe condition which can occur after cardiac surgery, especially among patients with pre-existing left ventricular dysfunction. Dobutamine, its first-line treatment, is associated with sinus tachycardia. This study aims to assess the ability of intravenous ivabradine to decrease sinus tachycardia associated with dobutamine infused for LCOS after coronary artery bypass graft (CABG) surgery. METHODS In a phase 2, multi-center, single-blind, randomized controlled trial, patients with left ventricular ejection fraction below 40% presenting sinus tachycardia of at least 100 beats per minute (bpm) following dobutamine infusion for LCOS after CABG surgery received either intravenous ivabradine or placebo (three ivabradine for one placebo). Treatment lasted until dobutamine weaning or up to 48 h. The primary endpoint was the proportion of patients achieving a heart rate (HR) in the 80- to 90-bpm range. Secondary endpoints were invasive and non-invasive hemodynamic parameters and arrhythmia events. RESULTS Nineteen patients were included. More patients reached the primary endpoint in the ivabradine than in the placebo group (13 (93%) versus 2 (40%); P = 0.04). Median times to reach target HR were 1.0 h in the ivabradine group and 5.7 h in the placebo group. Ivabradine decreased HR (112 to 86 bpm, P <0.001) while increasing cardiac index (P = 0.02), stroke volume (P <0.001), and systolic blood pressure (P = 0.03). In the placebo group, these parameters remained unchanged from baseline. In the ivabradine group, five patients (36%) developed atrial fibrillation (AF) and one (7%) was discontinued for sustained AF; two (14%) were discontinued for bradycardia. CONCLUSION Intravenous ivabradine achieved effective and rapid correction of sinus tachycardia in patients who received dobutamine for LCOS after CABG surgery. Simultaneously, stroke volume and systolic blood pressure increased, suggesting a beneficial effect of this treatment on tissue perfusion. TRIAL REGISTRATION European Clinical Trials Database: EudraCT 2009-018175-14 . Registered February 2, 2010.
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Affiliation(s)
- Lee S Nguyen
- Critical Care Medicine, CMC Ambroise Paré, Neuilly-sur-Seine, France
| | - Pierre Squara
- Critical Care Medicine, CMC Ambroise Paré, Neuilly-sur-Seine, France
| | - Julien Amour
- Anesthesiology and Critical Care Medicine, Hôpital de la Pitié-Salpétrière, AP-HP, and Université Pierre et Marie Curie, Paris, France
| | - Daniel Carbognani
- Anesthesiology and Critical Care Medicine, Institut Mutualiste Monsouris, Paris, France
| | - Kamel Bouabdallah
- Anesthesiology and Critical Care Medicine, Institut Mutualiste Monsouris, Paris, France
| | - Stéphane Thierry
- Anesthesiology and Critical Care Medicine, Centre Cardiologique du Nord, Saint-Denis, France
| | | | - Aurélie Moyne
- Institut de Recherches Internationales Servier, Suresnes, France
| | - Bernard Cholley
- Anesthesiology and Critical Care Medicine Department, Hôpital Européen Georges Pompidou, AP-HP, and Université Paris Descartes-Sorbonne Paris Cité, Paris, France.
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Delmas C, Leurent G, Lamblin N, Bonnefoy E, Roubille F. Cardiogenic shock management: Still a challenge and a need for large-registry data. Arch Cardiovasc Dis 2017; 110:433-438. [PMID: 28479041 DOI: 10.1016/j.acvd.2017.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 03/11/2017] [Accepted: 03/21/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Clement Delmas
- Intensive Cardiac Care Unit, Cardiology Department, University Hospital of Rangueil, Toulouse, France; Intensive Care Unit Rangueil, Anaesthesia and Critical Care Department, University Hospital of Rangueil, Toulouse, France.
| | - Guillaume Leurent
- Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, Université de Rennes 1, LTSI, INSERM, U1099, Rennes, France
| | - Nicolas Lamblin
- Université de Lille, INSERM, CHU de Lille, Institut Pasteur, U1167, Lille, France
| | - Eric Bonnefoy
- Hospices Civils de Lyon, Université Claude-Bernard Lyon 1, Lyon, France
| | - François Roubille
- Cardiology Department, University Hospital of Montpellier, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
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