Assuntos
Vacinas contra COVID-19/efeitos adversos , COVID-19/prevenção & controle , Miocardite , SARS-CoV-2/metabolismo , Vacinação/efeitos adversos , Vacina de mRNA-1273 contra 2019-nCoV , Adulto , Vacina BNT162 , COVID-19/sangue , Vacinas contra COVID-19/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Miocardite/sangue , Miocardite/induzido quimicamente , Miocardite/diagnóstico por imagem , Miocardite/fisiopatologiaRESUMO
BACKGROUND: In patients admitted for acute heart failure (HF) indication for drugs which reduce the heart rate (HR) is debated. The multicentre prospective study Reduction of heart Rate in Heart Failure (RedRate-HF) was designed to analyse the hemodynamic effects of an early reduction of HR in acute HF. METHODS: Hemodynamic parameters were recorded by using the bioimpedance technique, which was shown to be accurate, highly reproducible and sensitive to intra-observer changes. Lowering HR was obtained by ivabradine 5âmg bd, given 48-72âh after admission on the top of optimized treatment. Patients were followed at 24, 48, 72âh after drug assumption and at hospital discharge. RESULTS: Twenty patients of a mean age of 67â±â15 years, BNP at entry 1348â±â1198âpg/ml were enrolled. Despite a clinical stabilization, after 48-72âh from admission, HR was persistently >70âbpm. Ivabradine was well tolerated in all patients with a significant increase in RR interval from 747â±â69âms at baseline to 948â±â121 ms at discharge, Pâ<â0.0001. Change in HR was associated with a significant increase in stroke volume (baseline 73â±â22 vs. 84â±â19âml at discharge, Pâ=â0.03), and reduction in left cardiac work index (baseline 3.6â±â1.2 vs. 3.1â±â1.1âkg/m2 at discharge, Pâ=â0.04). Other measures of heart work were also significantly affected while cardiac output remained unchanged. CONCLUSION: The strategy of an early lowering of HR in patients admitted for acute HF on top of usual care is feasible and safe. The HR reduction causes a positive increase in stroke volume and may contribute to saving energy without affecting cardiac output.