Heart rate reduction strategy using ivabradine in end-stage Duchenne cardiomyopathy

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Abstract

BACKGROUND: End-stage dilated cardiomyopathy (DCM) is the leading cause of morbidity and mortality in patients with Duchenne Muscular Dystrophy (DMD). No studies are available on the effect of ivabradine on long-term outcomes in end-stage DMD/DCM.

METHODS: We prospectively enrolled a cohort of end-stage DMD/DCM patients with LV ejection fraction <40%, on chronic HF treatment with an ACE inhibitor referred consecutively from 2012 to 2017 to Bambino Gesù Children's Hospital. In each patient, before starting HRR strategy and after 1 year, we collected medical records comprehensive of clinical, demographic and imaging parameters, BNP levels, neurological and respiratory assessment.

RESULTS: Twenty male patients with DMD/DCM with a mean age of 15.0 ± 3.5 (13-19 IQR) years were enrolled and divided into 2 groups according to ivabradine therapy. This group showed a higher incidence of MACEs compared to others in treatment with ivabradine (87.5% vs 12.5%, p = 0.025). At Kaplan Meier survival analysis curves, the rate free from MACEs was higher in patients treated with ivabradine (log rank p = 0.017). At multivariate Cox regression analysis, ivabradine therapy was an independent predictor of freedom from MACEs (H.R. 0.078, 95% CI 0.007-0.877, p = 0.039).

CONCLUSION: HRR strategy, whether achieved by beta blockers alone or in combination with ivabradine, seemed to be effective in reducing the incidence of acute adverse events, reaching optimal target heart rate and improving left ventricular function in DMD/DCM patients.

Original languageEnglish
Pages (from-to)99-103
Number of pages5
JournalInternational Journal of Cardiology
Volume280
DOIs
Publication statusPublished - Apr 1 2019

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ivabradine
Cardiomyopathies
Duchenne Muscular Dystrophy
Dilated Cardiomyopathy
Heart Rate
Kaplan-Meier Estimate
Incidence
Therapeutics
Survival Analysis
Left Ventricular Function
Angiotensin-Converting Enzyme Inhibitors
Medical Records
Regression Analysis
Demography
Morbidity

Cite this

@article{03d0013b409140498114e15ce9dad8fc,
title = "Heart rate reduction strategy using ivabradine in end-stage Duchenne cardiomyopathy",
abstract = "BACKGROUND: End-stage dilated cardiomyopathy (DCM) is the leading cause of morbidity and mortality in patients with Duchenne Muscular Dystrophy (DMD). No studies are available on the effect of ivabradine on long-term outcomes in end-stage DMD/DCM.METHODS: We prospectively enrolled a cohort of end-stage DMD/DCM patients with LV ejection fraction <40{\%}, on chronic HF treatment with an ACE inhibitor referred consecutively from 2012 to 2017 to Bambino Ges{\`u} Children's Hospital. In each patient, before starting HRR strategy and after 1 year, we collected medical records comprehensive of clinical, demographic and imaging parameters, BNP levels, neurological and respiratory assessment.RESULTS: Twenty male patients with DMD/DCM with a mean age of 15.0 ± 3.5 (13-19 IQR) years were enrolled and divided into 2 groups according to ivabradine therapy. This group showed a higher incidence of MACEs compared to others in treatment with ivabradine (87.5{\%} vs 12.5{\%}, p = 0.025). At Kaplan Meier survival analysis curves, the rate free from MACEs was higher in patients treated with ivabradine (log rank p = 0.017). At multivariate Cox regression analysis, ivabradine therapy was an independent predictor of freedom from MACEs (H.R. 0.078, 95{\%} CI 0.007-0.877, p = 0.039).CONCLUSION: HRR strategy, whether achieved by beta blockers alone or in combination with ivabradine, seemed to be effective in reducing the incidence of acute adverse events, reaching optimal target heart rate and improving left ventricular function in DMD/DCM patients.",
author = "Rachele Adorisio and Camilla Calvieri and Nicoletta Cantarutti and Adele D'Amico and Michela Catteruccia and Enrico Bertini and Anwar Baban and Sergio Filippelli and Gianluigi Perri and Antonio Amodeo and Fabrizio Drago",
note = "Copyright {\circledC} 2019. Published by Elsevier B.V.",
year = "2019",
month = "4",
day = "1",
doi = "10.1016/j.ijcard.2019.01.052",
language = "English",
volume = "280",
pages = "99--103",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Heart rate reduction strategy using ivabradine in end-stage Duchenne cardiomyopathy

AU - Adorisio, Rachele

AU - Calvieri, Camilla

AU - Cantarutti, Nicoletta

AU - D'Amico, Adele

AU - Catteruccia, Michela

AU - Bertini, Enrico

AU - Baban, Anwar

AU - Filippelli, Sergio

AU - Perri, Gianluigi

AU - Amodeo, Antonio

AU - Drago, Fabrizio

N1 - Copyright © 2019. Published by Elsevier B.V.

PY - 2019/4/1

Y1 - 2019/4/1

N2 - BACKGROUND: End-stage dilated cardiomyopathy (DCM) is the leading cause of morbidity and mortality in patients with Duchenne Muscular Dystrophy (DMD). No studies are available on the effect of ivabradine on long-term outcomes in end-stage DMD/DCM.METHODS: We prospectively enrolled a cohort of end-stage DMD/DCM patients with LV ejection fraction <40%, on chronic HF treatment with an ACE inhibitor referred consecutively from 2012 to 2017 to Bambino Gesù Children's Hospital. In each patient, before starting HRR strategy and after 1 year, we collected medical records comprehensive of clinical, demographic and imaging parameters, BNP levels, neurological and respiratory assessment.RESULTS: Twenty male patients with DMD/DCM with a mean age of 15.0 ± 3.5 (13-19 IQR) years were enrolled and divided into 2 groups according to ivabradine therapy. This group showed a higher incidence of MACEs compared to others in treatment with ivabradine (87.5% vs 12.5%, p = 0.025). At Kaplan Meier survival analysis curves, the rate free from MACEs was higher in patients treated with ivabradine (log rank p = 0.017). At multivariate Cox regression analysis, ivabradine therapy was an independent predictor of freedom from MACEs (H.R. 0.078, 95% CI 0.007-0.877, p = 0.039).CONCLUSION: HRR strategy, whether achieved by beta blockers alone or in combination with ivabradine, seemed to be effective in reducing the incidence of acute adverse events, reaching optimal target heart rate and improving left ventricular function in DMD/DCM patients.

AB - BACKGROUND: End-stage dilated cardiomyopathy (DCM) is the leading cause of morbidity and mortality in patients with Duchenne Muscular Dystrophy (DMD). No studies are available on the effect of ivabradine on long-term outcomes in end-stage DMD/DCM.METHODS: We prospectively enrolled a cohort of end-stage DMD/DCM patients with LV ejection fraction <40%, on chronic HF treatment with an ACE inhibitor referred consecutively from 2012 to 2017 to Bambino Gesù Children's Hospital. In each patient, before starting HRR strategy and after 1 year, we collected medical records comprehensive of clinical, demographic and imaging parameters, BNP levels, neurological and respiratory assessment.RESULTS: Twenty male patients with DMD/DCM with a mean age of 15.0 ± 3.5 (13-19 IQR) years were enrolled and divided into 2 groups according to ivabradine therapy. This group showed a higher incidence of MACEs compared to others in treatment with ivabradine (87.5% vs 12.5%, p = 0.025). At Kaplan Meier survival analysis curves, the rate free from MACEs was higher in patients treated with ivabradine (log rank p = 0.017). At multivariate Cox regression analysis, ivabradine therapy was an independent predictor of freedom from MACEs (H.R. 0.078, 95% CI 0.007-0.877, p = 0.039).CONCLUSION: HRR strategy, whether achieved by beta blockers alone or in combination with ivabradine, seemed to be effective in reducing the incidence of acute adverse events, reaching optimal target heart rate and improving left ventricular function in DMD/DCM patients.

U2 - 10.1016/j.ijcard.2019.01.052

DO - 10.1016/j.ijcard.2019.01.052

M3 - Article

VL - 280

SP - 99

EP - 103

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -