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Treatment of patients with chronic heart failure (CHF) and preserved left ventricular (LV) ejection fraction remains largely empirical, as none of the methods of therapy improves the prognosis of patients. In a prospective randomized study on 126 patients with CHF and LV ejection fraction more or equal 50% we compared effectiveness of long-term treatment with bisoprolol (n=62) and ivabradine (n=64). Assessment of clinical status, exercise tolerance (ET), quality of life, blood level of N-terminal brain natriuretic peptide precursor, and parameters of echocardiography was performed at baseline and after 12 months of therapy. Unlike bisoprolol ivabradine, significantly improved exercise tolerance, quality of life, and reduced level of N-terminal brain natriuretic peptide precursor. Improvement of echocardiographic indices of active relaxation and compliance of the left ventricle was also observed. Key words: heart failure with preserved ejection fraction; ivabradine; bisoprolol; left ventricle diastolic dysfunction.

The aim of the study was to assess heart rate reduction for a acute decompensated heart failure in patients with reduced left ventricular systolic function and in patients with heart failure without significant reduction in ejection fraction. Were examined 79 patients with an ejection fraction less than 40%. 38 of them took If-channel blocker, ivabradine, 41 amounted to a control group. A group of patients with diastolic dysfunction was 48 patients (23 in the treatment of ivabradine and 25 subgroups of control). During the 14 days of observation it was found that the positive effect of reducing the sinus rate by ivabradine was observed in patients with diastolic dysfunction. In this group of patients on the background of decreasing heart rate, improves the passive diastolic properties of the left ventricle and an increase in the distance traveled by the patients during 6-minute walk test compared with the control group. The data obtained in our study support the use of ivabradine in patients with acute decompensated heart failure. The most significant changes in hemodynamic parameters and functional status were obtained in patients with diastolic dysfunction. Given the small sample, the results need to be further confirmed in larger clinical trials.

The results of Assessment Program effective treatment of patients with myocardiaL INfarction drug ProCORalan (ivabradine) in outpatient practice, conducted in 53 cities of the Russian Federation, 333 doctors. Included 1226 patients (822 men and 404 women, average age 60,1+/-9,3 years). Despite treatment, before inclusion in the patients maintained an average 8,17+/-8,60 (mediana 6) angina attacks per week, elevated blood pressure (141,8+/-20,3/86,2+/-11,6 mm Hg) and heart rate (84,5 +/-10,4 beats / min). Adding to ivabradine treatment for 16 weeks resulted in significant (p<0.00001) reduction in heart rate (up to 63,1+/-7,5 beats / min), the number of angina attacks per week (from 8.17 to 1.27) and need for nitroglycerin (from 7.69 to 0.89 tablets per week). Decreased the number of patients that called ambulance assistance (from 35.6 to 1.5%), and hospitalization (from 15.4 to 1.2%). There was a significant (p<0.00001) increase in evaluating the effectiveness of treatment (from 5,4+/-1,8 to 8,9 +/-1,3 points), reducing the risk stratification of patients (6,1+/-1,5 to 4 3+/-2,0 points), increased stability evaluation of state (from 5,6+/-1,9 to 3,7+/-2,2 points) and improved assessment of prognosis (from 5,7+/-2,0 to 3,6 +/-1,9 points). Expressed significantly positive effects observed after 1 month of therapy, after the effect became more pronounced. Significantly improved quality of life estimated by Seattle Angina Questionnaire and Minnesota Living with Heart Failure. The maximum recommended dose ivabradine of 15mg/day were given 50% of the patients, the dose of 10 mg/day - 28%. Adverse effects were reported in 3.3% of patients, of which, according to doctors associated with taking the drug - 0.82%. During follow up, 4 patients died. Thus, the addition of ivabradine to -blocker therapy, persons with a history of myocardial infarction and angina experiencing elevated heart rate, are the tactics of a rational and safe therapy.

We present analysis of a case history of a patient with rare congenital heart disorder - Bland-White-Garland syndrome. The 25 years old women was first diagnosed with this disorder during an examination in the cardiological department of the Moscow clinical hospital No83. The paper contains discussion of difficulties of diagnosis and peculiarities of management of adults with this pathology as well as of a problem of the choice of further therapeutic approaches.

We investigated impact of ivabradine on exercise capacity and quality of life in patients with stable angina and comorbid chronic obstructive pulmonary disease during treatment with -blockers. Ivabradine with -blockers reduced heart rate, increased exercise capacity and improved angina more effective than -blockers only. Quality of life associated with angina increased in patients with stage I and II chronic obstructive pulmonary disease. Addition of ivabradine to -blockers for 2 month did not produce adverse respiratory effects.

In order to assess effect of If-channel blocker ivabradine on severity of pulmonary hypertension in chronic obstructive pulmonary disease (COPD) we studied 60 patients with III-IV stage COPD. We divided these patients into 2 groups with similar clinical characteristics and therapy. Patients of one of these groups received ivabradine (10 mg/day) for 2 weeks, patients of another served as controls. The use of ivabradine was associated with statistically significant lowering of pulmonary hypertension, heart rate, and increase of exercise tolerance without negative effects on myocardial contractility, electrophysiological parameters, or data of spirometry.

Aim of the study - to determine efficacy of therapy with the use of ivabradine in patients with functional class (FC) III chronic heart failure (CHF) on the basis of assessment of its action on regulatory adaptive status (RAS). We included into the study 100 patients with FC III CHF at the background of ischemic heart disease (IHD) and/or stage III hypertensive disease (HD) receiving complex therapy (quinapril, torasemide, spironolactone). After randomization group 1 comprised 56 patients (age 62.9+/-1.8 years) who were prescribed slow release metoprolol succinate (59.1+/-4.5 mg/day). Group 2 comprised 44 patients (age 59.4+/-1.3 years) who were prescribed If channel inhibitor ivabradine (12.1+/-2.3 mg/day) if beta-blocker use was not possible. Examination at baseline and in 6 months included treadmillometry with assessment of maximal oxygen consumption (VO2 max) at exercise, echocardiography, 24-hour blood pressure monitoring, measurement of N-terminal pro-brain natriuretic peptide (NT-proBNP) in blood plasma. For objective qualitative assessment of the state of RAS we used a test of cardio-respiratory synchronism. Therapy with the use of ivabradine improved structural and functional state of the myocardium, elevated tolerance to exercise, caused positive changes of NT-proBNP concentration in blood plasma and VO2 max at exercise. Thus ivabradine probably can serve as alternative to -adrenoblockers when their use is not possible patients with FC III CHF at the background of IHD and/or stage III HD.

The study was aimed to assess the efficacy and safety of treating coronary heart disease (CHD) patients complicated with COPD using the combination of tolerable doses of -blocker bisoprolol and inhibitor If-channel ivabradine, compared with bisoprolol alone. A total of 50 patients were included (88% men, mean age 62.8+/-7.2 years) with stable angina and clinical signs of bronchoobstruction (84% with COPD and 16% with bronchial asthma in remission phase). At the study start, all patients received bisoprolol, the dose of which was titrated until the clinical signs of intolerance (most common - bronchoobstruction) appeared or worsened. Average dose of bisoprolol at the time of forced titration stop was 6.3+/-2.2 mg/day, mean heart rate (HR) decreased from 82.1+/-8.4 to 72.2+/-8.5 bpm. Then, the patients were randomized into two groups: patients of the first group (n=25) continued to take bisoprolol in tolerable dose, and patients of the second group were added ivabradine (5-15 mg, mean dose 10.7+/- 3.1 mg/day). In contrast to the bisoprolol alone, combination therapy resulted in further decrease of HR to an average of 62.6+/-4.1 bpm over 6 month of follow-up. This was associated with additional decrease of the number of angina attacks (by 4.68+/-4.40 per week vs. 2.48+/-4.70, &lt;0.05), nitrates consumption (by 206.0+/-153.6 mg/week vs. 95.6+/-134.2 mg/week, &lt;0.01) and score of negative components of quality of life (by 5.16+/-3.3 vs. 2.24+/-4.5, &lt;0.05), compared with the first group, respectively. In combination therapy group there was also the decrease of the inhaled broncholytics consumption (from 2.88+/-3.23 to 1.88+/-2.65 per week, &lt;0.05), that was not evident in the first group. Average number of hospitalizations per 1 patient decreased over 6 months of follow-up, compared to the same period before the trial, in both groups, but more prominently in the combination therapy group (-0.31+/-0.55 vs. -0.56+/-0.76, accordingly, &lt;0.1). Therefore, in the treatment of patients with CHD, stable angina and concomitant bronchoobsrtuctive manifestations, if not possible to administer -blockers in the adequate HR-reducing dose, the addition of ivabradine to the treatment could be the treatment of choice. The combination of tolerable doses of bisoprolol and ivabradine is s afe and allows to achieve adequate HR decrease. This is a ssociated with maximal antianginal effect, decrease in the need for broncholytic therapy, improvement of the quality of life and decrease of the number of hospitalizations, compared with the treatment with bisoprolol alone.

Unlabelled: URGENCY: Frequency of warm reductions (FWR) is the independent risk factor increasing frequency of the general death rate, sudden death rate and death rate from cardiovascular diseases. Aim of the work was to study dynamics of parameters of cardiovascular system in Patients with Stable Angina (SA) and Congestive Heart Failure (CHF) treated with Ivabradin within six months were investigated., Materials and Methods: 78 patients having symptoms of SA and CHF and also FWR more than 70 per 1 minute treated the maximum dose blokatorov, are divided into 2 groups. The patient of the first group (40 people) to standard therapy was added ivabradin. Patients of the second group (38 people) received the standard treatment of a SA and CHF. Before and after six months of the treatment the following findings were evaluated: the 6 minute walk test results, echocardiographic parameters, of heart rate variability (HRV), von Willebrand factor, endothelium dependent and independent vasodilation, main arteries rigidity., Results: The complex therapy including ivabradin, at examined patients promotes heart rate fall, to reduction of quantity of attacks of a stable angina and number of the accepted tablets of nitroglycerine, increase of CHF functional class, increase in shock volume left ventricular (LV) and certainly diastolichesky volume LV, to decrease in activity of the factor of Willebrand, quality of life. Indicators of HRV, endothelium dependent and independent vasodilation, main arteries rigidity during against 6 monthly therapies improve, but do not reach reliability degree.

The article is devoted to results of additional analysis of a randomized, double-blind, placebo-controlled, parallel-group BEAUTIFUL trial. Effects of If inhibitor ivabradine in patients with ischemic heart disease, left ventricular dysfunction and stable angina were analyzed.

Control of heart rate (HR) is an important target during treatment of patients with stable angina. In a number of cases it can be achieved by the use of beta-adrenoblockers. But often a necessity arises to enhance pulse slowing therapy with the use of combinations of drugs exerting negative chronotropic effect. We present here results of the CONTROL study (n=1777), conducted with the aim of studying antianginal efficacy and tolerability of the If-channels blocker ivabradine used in combination with beta-adrenoblockers in patients with stable functional class II-III angina and frequency of attacks > or = 3/week and HR>70 bpm. The use of ivabradine for 12 weeks allowed to achieve greater reduction of frequency of anginal attacks (by 4 per week, 95% confidence interval 3-6) compared with the group of usual care (treatment at physicians discretion). At the end of the study in ivabradine group 43% of patients had no angina at all, HR lowering < or =60 bpm was noted in 46% of patients (in the comparison group14 and 6%, respectively, p < 0.001). Reduction of frequency of attacks of angina correlated with HR lowering, more with pulse rate measured by patients themselves (r = 0.411, p < 0.001), than with values measured at visits to physicians (r = 0.266, p < 0.001). Rate of lethal outcomes as well as rate of nonfatal cardiovascular complications (myocardial infarction, stroke, urgent revascularization) were similar in compared groups. In ivabradine group compared with usual care group there were less hospitalizations (5.0 and 8.6%, respectively, p = 0.021), calls for emergency service (13.3 and 25.4%), and sick leaves (6.6 and 13.1%, p = 0.018). Adverse reactions were noted in 130 patients (8.7%) in ivabradine group and in 29 patients (10.0%) in usual care group p = 0.580).

Effect of therapy with 1-adrenoblocker bisoprolol and inhibitor of If channels ivabradine on parameters of 24-hour ECG monitoring (24hECGM) was studied in 64 patients with ischemic heart disease (stable angina) and chronic obstructive pulmonary disease (COPD). At the first stage all patients received bisoprolol. Parameters of external respiration function (ERF) and 24h ECG were registered before and after 4 months of bisoprolol administration. At stage 2 indications were determined for inclusion of ivabradine in the treatment scheme. At the background of therapy with bisoprolol we obtained significant lowering of heart rate (HR) both during day and night, as well as significant diminution of magnitude and duration of ischemic ST depression. In 44% of patients target HR range was not achieved. This conditioned the necessity to administer ivabradine. Therapy of patients with stable angina and concomitant COPD should begin with cardioselective -adrenoblockers (bisoprolol). Incorporation of inhibitor of If channels ivabradine in the treatment scheme is indicated if during treatment with -adrenoblockers average 24 hour HR according to data of 24hECGM exceeds 70 beats/min and deterioration of bronchial conductance according to ERF data occurs.