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Ivabradine: The Hope for a Good Treatment of Ischemic Heart Disease.
MedLine Citation:
PMID:  23394554     Owner:  NLM     Status:  Publisher    
Chronic stable angina pectoris (CSAP) is the most common manifestation of coronary artery disease (CAD). Angina pectoris occurs when there is an imbalance between myocardial perfusion and the demands of the myocardium. Elevated heart rate (HR) is an important pathophysiological variable that increases myocardial oxygen demand, and also limits tissue perfusion by reducing the duration of diastole during which most myocardial perfusion occurs. Elevated resting HR represent a  significant predictor of all-cause and cardiovascular mortality in the general population and patients with cardiovascular disease (CVD) because it aids progression of this one through the development of atherosclerosis, plaque destabilization, and initiation of arrhythmias. Since β-blockers reduce HR, they are currently viewed as the first line therapy for CSAP and are associated with an improved prognosis after acute myocardial infarction (AMI) or congestive heart failure (CHF). The classical treatments for HR reduction show such negative aspects. β-blockers therapy exert negative effects on regional myocardial blood flow and function when HR reduction is eliminated by atrial pacing. Calcium channel antagonists functionally antagonize coronary vasoconstriction mediated through α-adrenoreceptors and are thus devoid of this undesired effect, but the compounds are nevertheless negative inotrope. Ivabradine (IVA), a pure HR lowering drug, reduces the myocardial oxygen demand at exercise, contributes to the restoration of oxygen balance and therefore benefit in chronic CVD. No relevant negative effects are evidenced on cardiac conduction, contractility, relaxation, repolarization or blood pressure (BP). Beneficial effects of IVA have been demonstrated in CSAP and CHF, with optimal tolerability profile due to selective interaction with If  channel of sino atrial node cells. More recently, the indication of IVA has been extended for use in association with β-blockers in patients with CAD. The aim of this review is point out the attention of IVA in treatment of ischemic heart disease.
Graziano Riccioni
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-14
Journal Detail:
Title:  Current medicinal chemistry     Volume:  -     ISSN:  1875-533X     ISO Abbreviation:  Curr. Med. Chem.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-2-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9440157     Medline TA:  Curr Med Chem     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Intensive Cardiology Care Unit, San Camillo de Lellis Hospital, Manfredonia, Foggia, Italy.
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