Dissociation between heart rate reduction and left ventricular filling pressure in heart failure with preserved ejection fraction: a meta-analysis of ivabradine trials

Background

Heart rate (HR) reduction is commonly proposed to improve diastolic filling and reduce left ventricular (LV) filling pressure in heart failure with preserved ejection fraction (HFpEF). Ivabradine selectively lowers HR without direct myocardial effects, providing a mechanistic model to examine whether HR reduction alone translates into improved LV filling pressure. This study aims to evaluate whether selective HR reduction with ivabradine improves LV filling pressure and diastolic function in patients with HFpEF.