Background. Ranolazine (RAN) reduces cardiac sodium channel 1.5’s late sodium current in congestive heart failure
(CHF), reducing myocardial calcium overload, potentially improving left ventricular (LV) function. RAN blocks neuronal
sodium channel 1.7, potentially altering parasympathetic and sympathetic (P&S) activity. The effects of RAN on
LV ejection fraction (LVEF) and P&S function in CHF were studied.
Methods. Matched CHF patients were given open-label RAN (1000 mg po-bid) added to guideline-driven therapy
(RANCHF, 41 systolic, 13 diastolic) or no adjuvant therapy (control, NORANCHF, 43 systolic, 12 diastolic). Echocardiographic
LVEF and P&S measures were obtained at baseline and follow-up (mean 23.7 months).
Results. LVEF increased in 70% of RANCHF patients, an average of 11.3 units. Mean LVEF remained unchanged
in NORANCHF patients. P&S measures indicated cardiovascular autonomic neuropathy (P≤0.1 bpm2) in 20% of
NORANCHF patients at baseline and in 29% at follow-up (increasing in both groups). At baseline, 28% of patients
had high sympathovagal balance (SB), RAN normalized SB over 50% of these; in contrast, the NORANCHF group
had a 20% increase in patients with high SB.
Conclusions. RAN preserves or improves LVEF and decreases high SB in CHF.
Congestive heart failure, Left ventricular ejection fraction, Parasympathetic function, Patient outcomes, Ranolazine, Sympathetic function
Financial support: No grants or funding have been received for this
study.
Gary L. Murray Director, The Heart and Vascular Institute 7205 Wolf River Blvd Germantown TN, 38138, USA drglmurray@hotmail.com

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