Impact of rhBNP and ivabradine on outcomes, cardiac markers, and microcirculation in ischemic heart failure.

BACKGROUND

Ischemic cardiomyopathy (ICM) with heart failure (HF) is characterized by myocardial hypoxia, microcirculation dysfunction, and neuroendocrine activation. While ivabradine and recombinant human brain natriuretic peptide (rhBNP) are individually used for HF, their combined efficacy remains underexplored.

OBJECTIVE

To evaluate the effects of rhBNP combined with ivabradine on cardiac function, myocardial microcirculation, endocrine hormones, and biomarkers (CysC, Gal-3, miR-19a) in ICM-HF patients.

METHODS

In this prospective study, 126 ICM-HF patients were randomized 1:1 to either ivabradine alone (control) or rhBNP + ivabradine (intervention). Both groups received conventional therapy. Cardiac function (LVEF, LVESD, LVEDD), microcirculation parameters (ischemic burden, ST-segment shift), serum hormones (ALD, NE, Ang II), and biomarkers were assessed at baseline and after 1 month.

RESULTS

The intervention group showed higher total efficacy (93.65%¦vs. 76.19%, P<0.05), improved LVEF (51.76%¦vs. 46.68%), and reduced ventricular volumes (LVESD: 34.75 vs. 40.47 mm; P<0.05). Myocardial microcirculation parameters (ischemic burden, time, frequency) and neuroendocrine levels (ALD: 38.31 vs. 65.02 ng/L; NE: 102.39 vs. 180.23 ng/L; P<0.05) were significantly lower. Serum CysC, Gal-3, and miR-19a levels also decreased more prominently (P<0.05). Adverse reactions were comparable (11.11%¦vs. 7.94%, P>0.05).

CONCLUSION

rhBNP combined with ivabradine synergistically improves cardiac function, myocardial microcirculation, and neuroendocrine regulation in ICM-HF patients, with superior efficacy and safety.