EFFICACY OF SHORT-TERM TREATMENT WITH IVABRADINE IN POSTMENOPAUSAL WOMENWITH DEMONSTRATED ISCHEMIA
Background: Coronary heart disease (CHD is the most common cause of death among women. There are differences between women and men regarding clinical presentation, diagnosis and treatment in CHD. Also, there are differences between the proportion of women and men included in the randomized clinical trials studying different types of CHD, with a higher percent of men included. The aim of our study was to evaluate the short-term efficacy of anti-ischemic treatment with ivabradine in women with CHD with intermediate risk using non-invasive testing.
Methods: 25 post-menopausal women were included (age 61+/- 7 years) with stable angina class II CCS. All patients had an intermediate risk for cardiovascular events(SCORE scale) and normal left ventricular ejection fraction. They were treated at inclusion with either a beta-blocker or a non-dihydropyridine calcium antagonist. On top of their stable medication the patients received Ivabradine 5 mg bid, uptitrated to 7.5 mg bid in the first week in order to achieve a resting heart rate between 50 – 60 bpm. At inclusion and after 6 weeks of treatment with ivabradine the following test were performed: Seattle angina questionnaire, ecg exercise testing (EET) and 12-lead Holter monitoring (HM). It was used Cardiospy analysis software for all three types of testing, EC-12R/S system for EET, and EC-12H recorder for HM.
Results: At inclusion 20 patients out of 25 had a positive EETwith an ST-depression less than 1.5 mm. 17 out of 25 patients had silent transitory ST-depression revealed by the continuous ST-segment monitoring. No patient was free of ischemia. At the end of follow-up there was a statistically significant improvement in quality of life and a reduction in ischemic burden.
Conclusion: Ivabradine is an efficient short-term treatment for women with intermediate risk stable angina as showed by symptoms improvement and reduction of ischemic burden demonstrated with noninvasive ecg methods.