This is a monocentric, prospective, single arm, not for profit study. It is designed to study the early use of ivabradine in patients with dilated cardiomyopathy and Ejection Fraction (EF) \< 45%.
The study is divided into a screening and enrollment visit (V1) where eligibility for treatment will be confirmed. Ivabradine will be administered to eligible patients with increasing dosage during the titration period (TP) which will last from a minimum of 3 days to a maximum of 15 days. This will be followed by a maintenance period (MP) of the drug for a further 14 days. The follow-up period (FU) will last 4 months. The dose of ACE inhibitors will be introduced after 72 hours of clinical stability after the introduction of titrated ivabradine at maximum dose according to protocol. The anti-aldosterone will be introduced 24 hours after the introduction of ivabradine. The diuretic will not be modified during the titration phase of the drug, unless there is clinical necessity. During the FU ivabradine will be continued at stable dosage, in order to maintain the target heart rate (HR) reached during the maintenance phase (HR \> 80 bpm, in the group of patients older than 6-12 months, or HR \> 70 bpm in patients aged 1-3 years or HR \> 50 bpm between 3-18 years). In all patients, the drug dose will be decreased or discontinued in case of bradycardia (HR\< 80 bpm in patients 6-12 months, HR\< 70 bpm in patients 1-3 years of age or HR\< 60 bpm in patients 3-18 years of age) and/or symptoms related to bradycardia or for other safety reasons.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
9
Initial dose of ivabradine will be: 0.02 mg/kg/dose twice daily in patients between 6-12 months 0.05 mg/kg/dose twice daily in patients between 1-3 years and 3-18 years with a weight \< 40 kg 2.5 mg/day in patients between 3-18 years with weight \> 40 kg During titration phase, the dose may be increased, maintained, reduced or discontinued in accordance with titration rules. The titration rules will be adjusted on the basis of age subset and of each patient's evaluation during the titration phase, whether or not the target heart rate is reached (HR ≥ 20% compared to baseline HR) and whether or not are present bradycardia (HR should be greater than predefined by a HR threshold per age subset) and/or bradycardia-related symptoms. Maximum dose to be reached will be: 0.2 mg/kg/dose twice daily in patients between 6-12 months 0.3 mg/kg/dose twice daily in patients between 1-3 years and 3-18 years with a weight \< 40 kg 15 mg/day in patients between 3-18 years, weight \> 40 kg
Bambino Gesù Hospital and Research Institute
Rome, Italy
Heart rate in b.p.m. (mean (±SD) difference from baseline) at the end of maintenance
To assess the response to ivabradine on heart rate after 14 days of stable therapy
Time frame: At the end of the two weeks maintenance period (17-29 days from enrollment)
Heart rate in b.p.m. (mean (±SD) difference from baseline) at the end of follow-up
To assess the response to ivabradine on heart rate after 16 weeks of follow-up
Time frame: At the end of the 16 weeks follow-up period (129-141 days from enrollment)
Serum NT-proBNP in pg/mL (mean (±SD) difference from baseline) at the end of maintenance
To assess the response to ivabradine on serum NT-proBNP levels after 14 days of stable therapy
Time frame: At the end of the two weeks maintenance period (17-29 days from enrollment)
Serum NT-proBNP in pg/mL (mean (±SD) difference from baseline) at the end of follow-up
To assess the response to ivabradine on serum NT-proBNP levels after 16 weeks of follow-up
Time frame: At the end of the 16 weeks follow-up period (129-141 days from enrollment)
Correlation between heart rate and NT-proBNP value (Pearson correlation) at the end of maintenance
To assess the correlation between heart rate and serum NT-proBNP levels after 14 days of stable therapy
Time frame: At the end of the two weeks maintenance period (17-29 days from enrollment)
Correlation between heart rate and NT-proBNP value (Pearson correlation) at the end of follow-up
To assess the correlation between heart rate and serum NT-proBNP levels after 16 weeks of follow-up
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Time frame: At the end of the 16 weeks follow-up period (129-141 days from enrollment)
Left ventricular function, calculated by 2D echocardiographic technique (calculation of left ventricular volume and ejection fraction - mean (±SD) difference from baseline) at the end of maintenance
To assess EF, Left Ventricular End Diastolic Volume (LVEDV), Left Ventricular End Systolic Volume (LVESV) after 14 days of stable therapy
Time frame: At the end of the two weeks maintenance period (17-29 days from enrollment)
Left ventricular function, calculated by 2D echocardiographic technique (calculation of left ventricular volume and ejection fraction - mean (±SD) difference from baseline) at the end of follow-up
To assess EF, LVSV, LVDV after 16 weeks of follow-up
Time frame: At the end of the 16 weeks follow-up period (129-141 days from enrollment)
Systolic blood pressure in mmHg (mean (±SD) difference from baseline) at the end of maintenance
To assess the response to ivabradine on systolic blood pressure after 14 days of stable therapy
Time frame: At the end of the two weeks maintenance period (17-29 days from enrollment)
Systolic blood pressure in mmHg (mean (±SD) difference from baseline) at the end of follow-up
To assess the response to ivabradine on systolic blood pressure after 16 weeks of follow-up
Time frame: At the end of the 16 weeks follow-up period (129-141 days from enrollment)
Use of inotropic drugs (number and % of patients who had to use inotropes at the end of maintenance)
To assess the need to resort to inotropic drugs within 14 days of stable ivabradine therapy
Time frame: At the end of the two weeks maintenance period (17-29 days from enrollment)
Use of inotropic drugs (number and % of patients who had to use inotropes at the end of follow-up)
To assess the need to resort to inotropic drugs within 16 weeks of follow-up
Time frame: At the end of the 16 weeks follow-up period (129-141 days from enrollment)
Number and % of dropouts at the end of maintenance
To assess the frequency of patients who exit from the study within 14 days of stable ivabradine therapy
Time frame: At the end of the two weeks maintenance period (17-29 days from enrollment)
Number and % of dropouts at the end of follow-up
To assess the frequency of patients who exit from the study within 16 weeks of follow-up
Time frame: At the end of the 16 weeks follow-up period (129-141 days from enrollment)
Time (days) from start of ivabradine therapy and new episode of acute heart failure, and/or implantation of mechanical assist device at the end of follow up
To assess the period within main cardiological events would occur after the start of ivabradine therapy
Time frame: At the end of the 16 weeks follow-up period (129-141 days from enrollment)