AIM To evaluate the effect of ivabradine on endothelial functions in patients with coronary artery disease (CAD) after complete revascularization with percutaneous coronary angioplasty (PCI).
METHODS One hundred and sixty-one patients at least 30 days after PCI were randomized (T0) to receive ivabradine 4 mg twice daily (ivabradine group, n =81) or standard medical therapy (control group, n = 80). After 4 weeks (T1), ivabradine dose was adjusted up to 7.5 mg twice daily in patients with heart rate (HR) at rest 60 bpm and thereafter continued for additional 4 weeks (T2). At all times, brachial artery reactivity was assessed by flow-mediated dilatation (FMD) and nitroglycerin-mediated dilatation (NMD).
RESULTS No significant differences were observed at T0 between ivabradine group and control group in terms of HR (67 ± 6) vs. (68 ± 6) 1/min, FMD (9 ± 4) vs. (8 ± 6)% and NMD (13 ± 7) vs. (13 ± 6)%. Over the study period, a significant reduction of HR (65 ± 6) 1/min at T1, (62 ± 5) 1/min at T2; P < 0.01 and improvement of FMD (12 ± 6) % at T1, (15 ± 8) % at T2; P < 0.01 and NMD (16 ± 10) at T1, (17 ± 9) at T2; P < 0.01 were observed in ivabradine group, while no significant changes were observed in control group. In ivabradine group, a moderate negative correlation was observed between HR variation and FMD variation from T1 to T3 (r = −0.426; P = 0.003).
CONCLUSIONS In CAD patients undergoing complete revascularization with PCI, ivabradine added to the standard medical therapy produces a significant improvement in endothelial functions. This effect seems to be related to HR reduction.
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