Ivabradine:一个独特和有趣的治疗心血管疾病的药物。

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Nawarskas JJ,鲍曼BN,安德森

Ivabradine:一个独特和有趣的治疗心血管疾病的药物。

心功能杂志启2015 Jul-Aug; 23(4): 201 - 11所示。doi: 10.1097 / CRD.0000000000000070。

PubMed ID

25839989 (在PubMed

]

文摘

已经有许多研究静息心率升高与心血管发病率和死亡率。基于这些发现,较低静息心率的理论心血管疾病患者受益。从病理生理的角度来看,较低静息心率会特别受益缺血性心脏病患者和/或心力衰竭。虽然β受体阻断剂和nondihydropyridine钙通道阻滞剂是有效地降低心率,他们有许多其他药理作用,在一些患者可能不是理想的,比如- inotropy。Ivabradine药物被设计来降低心率没有任何其他明显的药理作用;换句话说,一个纯净的心灵rate-lowering药物。它功能通过阻断hyperpolarization-activated环核苷酸封闭的通道(f-channels)特定的窦房结,如果离子电流干扰。这有效地延长舒张去极化,降低窦房结射击,降低心率。ivabradine的影响最为明显,在更高的心率(use-dependence),这是很重要的在减少症状性心动过缓的发展。临床试验证明ivabradine成为一个有效的减轻心绞痛的药物单独和结合β受体阻滞剂治疗,尽管它还没有被证明产生显而易见的影响减少主要不良心血管事件。 In patients with heart failure, ivabradine has demonstrated many hemodynamic benefits, but its effect on clinical outcomes have been mixed and dependent on baseline heart rate, ie, the drug may be of benefit with higher baseline heart rates, but detrimental with low baseline heart rates. The adverse effects of ivabradine are not uncommon, but are rarely severe and include visual disturbances, bradycardia, and atrial fibrillation. Although ivabradine is a very interesting new agent, its variable benefits in large-scale clinical trials leave its exact place in therapy still somewhat nebulous. Unanswered questions include which patient populations would benefit most from this drug, and which concomitant medications would produce the best clinical outcomes when used with ivabradine.

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药物

Ivabradine