Ivabradine (Procoralan)

peer reviewedIvabradine (Procoralan), a new If inhibitor which acts specifically and in a dose-dependent manner on the pacemaker activity of the sinoatrial node, is a pure heart rate lowering agent. It slows the diastolic depolarization slope of sinoatrial node cells and reduces heart rate at rest and during exercise. It has shown anti-ischaemic and anti-anginal activity at recommended doses of 5 and 7.5 mg bid in patients with stable angina. Ivabradine is as effective as atenolol and amlodipine to prevent or attenuate exercise-induced ischaemia in these patients. It is well tolerated, with transient visual symptoms being the main drug-related adverse event. These symptoms may be linked to the presence in the retina of ion channels similar to cardiac If channels and did not adversely affect the tolerability of the drug for most patients. In Belgium, ivabradine is currently reimbursed in patients with stable angina and normal sinus rhythm who do not tolerate beta-blockers and non-dihydropyridine calcium antagonists or in whom these treatments are contra-indicated

The Conundrum of Tricuspid Regurgitation Grading

Findings from early percutaneous tricuspid intervention trials have shown that the severity of tricuspid regurgitation (TR) far exceeded the current definition of severe TR. Also, the improvement in the amount of TR following tricuspid intervention is not accounted for by the current definition of TR as different degrees of severity at the severe end was grouped under the same umbrella term of “severe.” There has been a recent call to expand the TR grading system, encompassing two more grades, namely “massive” and “torrential” TR, in the order of increasing severity. This seems appropriate as the patients enrolled in tricuspid intervention trials were found to have TR severity up to 2 grades above the current severe thresholds of effective regurgitant orifice area (EROA) 40 mm2, regurgitant volume (R Vol) 45 ml and vena contracta (VC) width 7 mm. The proposed grade of “massive” is defined by EROA 60–79 mm2, R Vol 60–74 ml and VC 14–20 mm, while “torrential” is defined by EROA ≥80 mm2, R Vol ≥75 ml, and VC ≥21 mm. The grading of TR requires a comprehensive, multi-parametric approach. In particular, quantitative assessment of TR should be performed in patients who require serial monitoring and quantification of treatment effect

Mitral regurgitation in patients with systolic heart failure: more than a bystander

Peer reviewe

Chronic ischemic mitral regurgitation

peer reviewe

Quantitative Three-Dimensional Color Flow Echocardiography of Chronic Mitral Regurgitation: New Methods, New Perspectives, New Challenges

peer reviewe

Pulmonary pressures and outcome in primary mitral regurgitation. Paradigm shift from Rung to Ladder

Peer reviewe