Early NT‐proBNP Decrease With Ivabradine in Ambulatory Patients With Systolic Heart Failure

Abstract

Background

Heart rate ( HR) reduction in patients with systolic heart failure ( HF) is a cornerstone of current therapy. The aim of this study was to evaluate the short‐term effect of the HR reduction with ivabradine on N‐terminal pro‐brain natriuretic peptide ( NT‐proBNP) in outpatients with systolic HF.

Hypothesis

Ivabradine improves survival and promotes left ventricle remodelling by reducing resting heart rate. Nt‐ProBNP absolute and trends predict prognosis. We hypothesized a possible association between heart rate decrease and Nt‐ProBNP values.

Methods

We included 25 outpatients with systolic HF on optimized medical therapy (80% on angiotensin‐converting enzyme inhibitors, 56% on spironolactone, and 88% on β‐blocker therapy), left ventricle ejection fraction <40%, and sinus rhythm and HR >70/bpm. After a 1 month running‐out period, to establish the clinical and NT‐proBNP stability, patients were started on ivabradine for 3 months.

Results

Ivabradine decreased NT‐proBNP ( P = 0.002) from a median of 2850 pg/ mL to 1802 pg/ mL, corresponding to a median absolute and percent decrease of 964 pg/ mL and 44.5%, respectively. The baseline HR correlated significantly with the baseline NT‐proBNP ( r _s = 0.411, P = 0.041). The absolute and percent HR decrease correlated with the absolute NT‐proBNP decrease ( r _s = 0.442, P = 0.027; r _s = 0.395, P = 0.05). The greater the NT‐proBNP absolute decrease tertile, the greater the baseline HR ( P = 0.023) and the absolute ( P = 0.028) and percent ( P = 0.064) HR variation.

Conclusions

In outpatients with systolic HF, the NT‐proBNP reduction obtained by short‐term ivabradine treatment correlates closely with the degree of HR reduction.