medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2016-13-74-80medsovet-1366Research ArticleСердечная недостаточностьHeart failureТерапевтическое воздействие на частоту сердечных сокращений: видимая простота и реальная сложностьTHERAPEUTIC EFFECT ON HEART RATE: VISIBLE SIMPLICITY AND REAL DIFFICULTYГИЛЯРЕВСКИЙС. Р.GILYAREVSKYS. R.

д.м.н., профессор

Москва

MD, Prof.

ГОЛШМИДМ. В.GOLSHMIDM. V.

к.м.н.

Москва

PhD in medicine

КУЗЬМИНАИ. М.KUZMINAI. M.

к.м.н.

Москва

PhD in medicine

Российская медицинская академия последипломного образования Минздрава РоссииРоссияSBEI APE Russian Medical Academy of Postgraduate Education of the Ministry of Health of the Russian FederationRussian FederationНаучно-исследовательский институт скорой помощи им. Н.В. СклифосовскогоРоссияSBHI Sklifosovky Scientific and Research Institute of Ambulance Service of Moscow Healthcare DepartmentRussian Federation2016301220160137480Copyright © ГИЛЯРЕВСКИЙ С.Р., ГОЛШМИД М.В., КУЗЬМИНА И.М., 20162016ГИЛЯРЕВСКИЙ С.Р., ГОЛШМИД М.В., КУЗЬМИНА И.М.GILYAREVSKY S.R., GOLSHMID M.V., KUZMINA I.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/1366

В статье обсуждается клиническое значение повышенной частоты сердечных сокращений (ЧСС) как у здоровых лиц, так и больных с сердечно-сосудистыми заболеваниями. Обсуждаются результаты крупных рандомизированных исследований, посвященных оценке эффектов применения ивабрадина у больных с коронарной болезнью сердца и хронической сердечной недостаточностью, а также результаты исследований. Обсуждаются результаты анализа, свидетельствующие о положительном влиянии снижения ЧСС за счет применения ивабрадина на ремоделирование левого желудочка. Приводятся данные, которые могут подтверждать обоснованность раннего добавления ивабрадина к β-блокаторам на стационарном этапе лечения больных, которые были госпитализированы по поводу утяжеления сердечной недостаточности.

The article provides discussion of the clinical importance of the increased heart rate in healthy persons and in cardiovascular disease affected patients. Results of large randomized studies devoted to evaluation of ivabradine effect evaluation in patients with coronary heart disease and chronic cardiac insufficiency, as well as study results. Results of analysis evidencing positive effect of heart rate reduction due to ivabradine use on the left ventricle remodeling are discussed. Data are provided that might confirm justification of the early addition of ivabradine to β-adrenergic blocking agents at the stationary stage of the patients therapy who were hospitalized due to cardiac insufficiency aggravation.

сердечно-сосудистые заболеваниясердечная недостаточностьчастота сердечных сокращенийивабрадинcardiovascular insufficiencyheart rateivabradineReferencesBöhm M, Reil JC, Deedwania P et al. Resting heart rate: risk indicator and emerging risk factor in cardiovascular disease. Am J Med, 2015, 128: 219-228.Böhm M, Reil JC, Deedwania P et al. Resting heart rate: risk indicator and emerging risk factor in cardiovascular disease. Am J Med, 2015, 128: 219-228.Sabbah HN, Ilsar I, Zaretsky A et al. Vagus nerve stimulation in experimental heart failure. Heart Fail Rev, 2011, 16: 171-178.Sabbah HN, Ilsar I, Zaretsky A et al. Vagus nerve stimulation in experimental heart failure. Heart Fail Rev, 2011, 16: 171-178.Swedberg K, Komajda M, Böhm M et al. Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study. Lancet, 2010, 376: 847-849.Swedberg K, Komajda M, Böhm M et al. Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study. Lancet, 2010, 376: 847-849.Bö hm M, Reil JC. Heart rate: surrogate or target in the management of heart failure? Heart, 2013, 99: 72-75.Bö hm M, Reil JC. Heart rate: surrogate or target in the management of heart failure? Heart, 2013, 99: 72-75.Biel M, Wahl-Schott C, Michalakis S, Zong X. Hyperpolarization-activated cation channels: from genes to function. Physiol Rev, 2009, 89: 847-885.Biel M, Wahl-Schott C, Michalakis S, Zong X. Hyperpolarization-activated cation channels: from genes to function. Physiol Rev, 2009, 89: 847-885.Palatini P. Elevated heart rate: a «new» cardiovascular risk factor? Prog Cardiovasc Dis, 2009, 52: 1-5.Palatini P. Elevated heart rate: a «new» cardiovascular risk factor? Prog Cardiovasc Dis, 2009, 52: 1-5.DiFrancesco D. Funny channels in the control of cardiac rhythm and mode of action of selective blockers. Pharmacol Res, 2006, 53: 399-406.DiFrancesco D. Funny channels in the control of cardiac rhythm and mode of action of selective blockers. Pharmacol Res, 2006, 53: 399-406.Brown HF, DiFrancesco D, Noble SJ. How does adrenaline accelerate the heart? Nature, 979, 280: 235-236.Brown HF, DiFrancesco D, Noble SJ. How does adrenaline accelerate the heart? Nature, 979, 280: 235-236.DiFrancesco D, Camm JA. Heart rate lowering by specific and selective I(f) current inhibition with ivabradine: a new therapeutic perspective in cardiovascular disease. Drugs, 2004, 64: 1757-1765.DiFrancesco D, Camm JA. Heart rate lowering by specific and selective I(f) current inhibition with ivabradine: a new therapeutic perspective in cardiovascular disease. Drugs, 2004, 64: 1757-1765.Dyer AR, Persky V, Stamler J et al. Heart rate as a prognostic factor for coronary heart pisease and mortality: findings in three Chicago epidemiologic studies. Am J Epidemiol, 1980, 112: 736-749.Dyer AR, Persky V, Stamler J et al. Heart rate as a prognostic factor for coronary heart pisease and mortality: findings in three Chicago epidemiologic studies. Am J Epidemiol, 1980, 112: 736-749.Gillum RF, Makuc DM, Feldman JJ. Pulse rate, coronary heart disease, and death: the NHANES I Epidemiologic Follow-up Study. Am Heart J, 1991, 121: 172-177.Gillum RF, Makuc DM, Feldman JJ. Pulse rate, coronary heart disease, and death: the NHANES I Epidemiologic Follow-up Study. Am Heart J, 1991, 121: 172-177.Kannel WB, Kannel C, Paffenbarger RS, Cupples LA. Heart rate and cardiovascular mortality: the Framingham Study. American Heart Journal, 1987, 113: 1489-1494.Kannel WB, Kannel C, Paffenbarger RS, Cupples LA. Heart rate and cardiovascular mortality: the Framingham Study. American Heart Journal, 1987, 113: 1489-1494.Singh BN. Morbidity and mortality in cardiovascular disorders: impact of reduced heart rate. J Cardiovasc Pharmacol Ther. 2001, 6: 313-331.Singh BN. Morbidity and mortality in cardiovascular disorders: impact of reduced heart rate. J Cardiovasc Pharmacol Ther. 2001, 6: 313-331.Carnethon MR, Yan L, Greenland P et al. Resting heart rate in middle age and diabetes development in older age. Diabetes Care, 2008, 31: 335-339.Carnethon MR, Yan L, Greenland P et al. Resting heart rate in middle age and diabetes development in older age. Diabetes Care, 2008, 31: 335-339.Shigetoh Y, Adachi H, Yamagishi S et al. Higher heart rate may predispose to obesity and diabetes mellitus: 20-year prospective study in a general population. Am J Hypertens, 2009, 22: 151-155.Shigetoh Y, Adachi H, Yamagishi S et al. Higher heart rate may predispose to obesity and diabetes mellitus: 20-year prospective study in a general population. Am J Hypertens, 2009, 22: 151-155.Fox K, Ford I, Steg PG et al. Ivabradine in stable coronary artery disease without clinical heart failure. N Engl J Med, 2014, 371: 1091-1099.Fox K, Ford I, Steg PG et al. Ivabradine in stable coronary artery disease without clinical heart failure. N Engl J Med, 2014, 371: 1091-1099.Dharod A, Soliman EZ, Dawood F et al. Association of Asymptomatic Bradycardia With Incident Cardiovascular Disease and Mortality: The Multi-Ethnic Study of Atherosclerosis (MESA). JAMA Intern Med, 2016, 176: 219-227.Dharod A, Soliman EZ, Dawood F et al. Association of Asymptomatic Bradycardia With Incident Cardiovascular Disease and Mortality: The Multi-Ethnic Study of Atherosclerosis (MESA). JAMA Intern Med, 2016, 176: 219-227.Gaziano TA, Opie LH, Weinstein MC. Cardiovascular disease prevention with a multidrug regimen in the developing world: a cost-effectiveness analysis. Lancet, 2006, 368: 679-686.Gaziano TA, Opie LH, Weinstein MC. Cardiovascular disease prevention with a multidrug regimen in the developing world: a cost-effectiveness analysis. Lancet, 2006, 368: 679-686.Townsend N, Wilson L, Bhatnagar P et al. Cardiovascular disease in Europe: pidemiological update 2016. Eur Heart J, 2016 Aug 14. pii: ehw334. [Epub ahead of print].Townsend N, Wilson L, Bhatnagar P et al. Cardiovascular disease in Europe: pidemiological update 2016. Eur Heart J, 2016 Aug 14. pii: ehw334. [Epub ahead of print].Fihn SD, Blankenship JC, Alexander KP et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation, 2014, 130: 1749-1767.Fihn SD, Blankenship JC, Alexander KP et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation, 2014, 130: 1749-1767.Maddox TM, Chan PS, Spertus JA et al. Variations in coronary artery disease secondary prevention prescriptions among outpatient cardiology practices: insights from the NCDR (National Cardiovascular Data Registry). J Am Coll Cardiol, 2014, 63: 539-546.Maddox TM, Chan PS, Spertus JA et al. Variations in coronary artery disease secondary prevention prescriptions among outpatient cardiology practices: insights from the NCDR (National Cardiovascular Data Registry). J Am Coll Cardiol, 2014, 63: 539-546.Hjemdahl P, Eriksson SV, Held C et al. Favourable long term prognosis in stable angina ectoris: an extended follow up of the angina prognosis study in Stockholm (APSIS). Heart, 2006, 92: 177-182.Hjemdahl P, Eriksson SV, Held C et al. Favourable long term prognosis in stable angina ectoris: an extended follow up of the angina prognosis study in Stockholm (APSIS). Heart, 2006, 92: 177-182.Katritsis DG, Ioannides JP. Percutaneous coronary intervention versus conservative therapy in nonacute coronary artery disease: a metaanalysis. Circulation, 2005, 111: 2906- 912.Katritsis DG, Ioannides JP. Percutaneous coronary intervention versus conservative therapy in nonacute coronary artery disease: a metaanalysis. Circulation, 2005, 111: 2906- 912.Boden WE, O’Rourke RA, Teo KK et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med, 2007, 356: 1503-1516.Boden WE, O’Rourke RA, Teo KK et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med, 2007, 356: 1503-1516.Montalescot G, Sechtem U, Achenbach S et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J, 2013, 34: 2949-3003.Montalescot G, Sechtem U, Achenbach S et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J, 2013, 34: 2949-3003.Borer JS, Fox K, Jaillon P, Lerebours G. Antianginal and antiischemic effects of ivabradine, an I(f) inhibitor, in stable angina: a randomized, double-blind, multicentered, placebocontrolled trial. Circulation, 2003, 107: 817-823.Borer JS, Fox K, Jaillon P, Lerebours G. Antianginal and antiischemic effects of ivabradine, an I(f) inhibitor, in stable angina: a randomized, double-blind, multicentered, placebocontrolled trial. Circulation, 2003, 107: 817-823.Tardif J-C, Ford I, Bourassa MG, Fox K. Efficacy of ivabradine, a new selective If inhibitor, compared with atenolol in patients with chronic stable angina. Eur Heart J, 2005, 26: 2529- 2536.Tardif J-C, Ford I, Bourassa MG, Fox K. Efficacy of ivabradine, a new selective If inhibitor, compared with atenolol in patients with chronic stable angina. Eur Heart J, 2005, 26: 2529- 2536.Ruzyllo W, Tendera M, Ford I, Fox KM. Antianginal efficacy and safety of ivabradine compared with amlodipine in patients with stable effort angina pectoris: a 3-month randomised, double-blind, multicentre, noninferiority trial. Drugs, 2007, 67: 393-405.Ruzyllo W, Tendera M, Ford I, Fox KM. Antianginal efficacy and safety of ivabradine compared with amlodipine in patients with stable effort angina pectoris: a 3-month randomised, double-blind, multicentre, noninferiority trial. Drugs, 2007, 67: 393-405.Tardif JC, Ponikowski P, Kahan T. Efficacy of the I(f) current inhibitor ivabradine in patients with chronic stable angina receiving beta-blocker therapy: a 4-month, randomized, placebo-controlled trial. Eur Heart J, 2009, 30: 540-548.Tardif JC, Ponikowski P, Kahan T. Efficacy of the I(f) current inhibitor ivabradine in patients with chronic stable angina receiving beta-blocker therapy: a 4-month, randomized, placebo-controlled trial. Eur Heart J, 2009, 30: 540-548.Dillinger JG, Maher V, Vitale C et al. Impact of Ivabradine on Central Aortic Blood Pressure and Myocardial Perfusion in Patients With Stable Coronary Artery Disease. Hypertension, 2015, 66: 1138-1144.Dillinger JG, Maher V, Vitale C et al. Impact of Ivabradine on Central Aortic Blood Pressure and Myocardial Perfusion in Patients With Stable Coronary Artery Disease. Hypertension, 2015, 66: 1138-1144.European Medicines Agency recommends measures to reduce risk of heart problems with Corlentor/ Procoralan (ivabradine). EMA/705247/2014.European Medicines Agency recommends measures to reduce risk of heart problems with Corlentor/ Procoralan (ivabradine). EMA/705247/2014.Pocock SJ, Wang D, Pfeffer MA et al. Predictors of mortality and morbidity in patients with chronic heart failure. Eur Heart J, 2006, 27: 65-75.Pocock SJ, Wang D, Pfeffer MA et al. Predictors of mortality and morbidity in patients with chronic heart failure. Eur Heart J, 2006, 27: 65-75.Flannery G, Gehrig-Mills R, Billah B, Krum H. Analysis of randomized controlled trials on the effect of magnitude of heart rate reduction on clinical outcomes in patients with systolic chronic heart failure receiving beta-blockers. Am J Cardiol, 2008, 101: 865-869.Flannery G, Gehrig-Mills R, Billah B, Krum H. Analysis of randomized controlled trials on the effect of magnitude of heart rate reduction on clinical outcomes in patients with systolic chronic heart failure receiving beta-blockers. Am J Cardiol, 2008, 101: 865-869.Komajda M, Follath F, Swedberg K et al. The EuroHeart Failure Survey programme – a survey on the quality of care among patients with heart failure in Europe. Part 2: treatment. Eur Heart J, 2003, 24: 464-474.Komajda M, Follath F, Swedberg K et al. The EuroHeart Failure Survey programme – a survey on the quality of care among patients with heart failure in Europe. Part 2: treatment. Eur Heart J, 2003, 24: 464-474.Ponikowski P, Voors AA, Anker SD et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J, 2016, 37: 2129-2200.Ponikowski P, Voors AA, Anker SD et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J, 2016, 37: 2129-2200.Cohn JN, Ferrari R, Sharpe N. Cardiac remodeling – concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. On Behalf of an International Forum on Cardiac Remodeling. J Am Coll Cardiol, 2000, 35: 569-582.Cohn JN, Ferrari R, Sharpe N. Cardiac remodeling – concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. On Behalf of an International Forum on Cardiac Remodeling. J Am Coll Cardiol, 2000, 35: 569-582.St John Sutton M, Pfeffer MA, Plappert T et al. Quantitative two-dimensional chocardiographic measurements are major predictors of adverse cardiovascular events after acute myocardial infarction. The protective effects of captopril. Circulation, 1994, 89: 68-75.St John Sutton M, Pfeffer MA, Plappert T et al. Quantitative two-dimensional chocardiographic measurements are major predictors of adverse cardiovascular events after acute myocardial infarction. The protective effects of captopril. Circulation, 1994, 89: 68-75.Solomon SD, Anavekar N, Skali H et al. Influence of ejection fraction on cardiovascular outcomes in a broad spectrum of heart failure patients. Circulation, 2005, 112: 3738-3744.Solomon SD, Anavekar N, Skali H et al. Influence of ejection fraction on cardiovascular outcomes in a broad spectrum of heart failure patients. Circulation, 2005, 112: 3738-3744.St John Sutton M, Ghio S, Plappert T et al. Cardiac resynchronization induces major structural and functional reverse remodeling in patients with New York Heart Association class I/II heart failure. Circulation, 2009, 120: 1858-1865.St John Sutton M, Ghio S, Plappert T et al. Cardiac resynchronization induces major structural and functional reverse remodeling in patients with New York Heart Association class I/II heart failure. Circulation, 2009, 120: 1858-1865.Gheorghiade M, Abraham WT, Albert NM et al. Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure. JAMA, 2006, 296: 2217-2226.Gheorghiade M, Abraham WT, Albert NM et al. Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure. JAMA, 2006, 296: 2217-2226.Komajda M, Tavazzi L, Swedberg K et al. Chronic exposure to ivabradine reduces readmissions in the vulnerable phase after hospitalization for worsening systolic heart failure: a post-hoc analysis of SHIFT. Eur J Heart Fail, 2016 May 22. [Epub ahead of print].Komajda M, Tavazzi L, Swedberg K et al. Chronic exposure to ivabradine reduces readmissions in the vulnerable phase after hospitalization for worsening systolic heart failure: a post-hoc analysis of SHIFT. Eur J Heart Fail, 2016 May 22. [Epub ahead of print].Hidalgo FJ, Anguita M, Castillo JC et al. Effect of early treatment with ivabradine combined with beta-blockers versus beta-blockers alone in patients hospitalised with heart failure and reduced left ventricular ejection fraction (ETHIC-AHF): A randomised study. Int J Cardiol, 2016, 217: 7-11.Hidalgo FJ, Anguita M, Castillo JC et al. Effect of early treatment with ivabradine combined with beta-blockers versus beta-blockers alone in patients hospitalised with heart failure and reduced left ventricular ejection fraction (ETHIC-AHF): A randomised study. Int J Cardiol, 2016, 217: 7-11.

The authors declare that there are no conflicts of interest present.