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Ivabradine increases haemodynamic exercise performance after cardiac transplantation : a prospective study

Session Poster Session III - Friday 08:30 - 12:30

Speaker Thomas Jaussaud

Event : ESC Preventive Cardiology (Formerly EuroPrevent) 2015

  • Topic : preventive cardiology
  • Sub-topic : Exercise Testing
  • Session type : Poster Session

Authors : J Jaussaud (Bordeaux,FR), MA Billes (Bordeaux,FR), H Douard (Bordeaux,FR)

Authors:
J Jaussaud1 , MA Billes1 , H Douard1 , 1Hospital Haut Leveque - Bordeaux-Pessac - France ,

Citation:

Introduction: Cardiac graft denervation induces permanent sinus tachycardia that can be reduced with If channel antagonist Ivabradine. We aim to investigate the impact of long term Ivabradine treatment on cardiopulmonary performance in heart transplant recipients.

 Methods: This prospective cross-over study included 16 patients (12 males; 53± 8 years) transplanted since 5 ± 4 years with stable sinus rhythm and normal graft systolic function. Each patient performed a cardiopulmonary exercise test after a 3 months period without and after 3 months of Ivabradine therapy (5 mg bid) in a randomized order.

Results: Heart rhythm (HR) at rest, at first ventilatory threshold and at peak exercise were significantly reduced (99±5 bpm to 77±7 bpm (p < 0.001); 123±9 bpm to 103±11 bpm (p < 0.001) and 151± 9 bpm to 134±11 bpm (p<0.001)). A trend to an improvement of peak aerobic (VO2 max) and exercise performance (from 20± 5 to 21±5 ml/kg/min and from 110± 33 to 116± 43 watts -p=ns-) and at ventilatory threshold (14±3 to 15±5 ml/kg/min -p=ns-) were observed. VE/VCO2 slope was stable (from 35± 6 to 36± 5 - p = ns-). Nevertheless, peak oxygen pulse was significantly increased by Ivabradine therapy from 46 +/- 6 % to 55± 8 % of theorical value -p = 0.03- assessing a probable improvement of stroke volume during exercise. No side effect nor significant changes in immunosuppressive drug dosages were detected during treatment periods. Blood pressure were not statically changed during exercise measurements.

Conclusion: Despite a slight but not significant improvement in oxydative and exercise capacities, chronic Ivabradine therapy in heart transplant recipients induces a significant increase of peak exercise stroke volume assessed by oxygen pulse. This could be explained by a significant reduction of HR and then a longer left ventricular diastolic filling time during exercise.

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