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Ranolazine improves autonomic balance in heart failure when added to guideline-driven therapy

Heart International. 2014;9(2):59-65


Background. The effect of ranolazine (RAN) on cardiac autonomic balance in congestive heart failure (CHF) was studied. Methods. Fifty-four CHF patients were randomized to (1) open-label RAN (RANCHF) added to usual therapy vs. (2) usual therapy (NORANCHF). Parasympathetic and sympathetic (P&S) measurements were taken at baseline and at 12 months. Results. A total of 16/27 (59%) patients in both groups had initially abnormal P&S measures, including high sympathovagal balance (SB), cardiovascular autonomic neuropathy (CAN) or both. High SB normalized in 10/12 (83%) RANCHF patients vs. 2/11 (18%) NORANCHF patients. SB became high in 5/11 (45%) NORANCHF vs. 1/11 (9%) RANCHF patients. CAN improved in 4/6 (67%) RANCHF patients vs. 5/7 (45%) NORANCHF patients. CAN developed in 1/11 (9%) RANCHF vs. 4/11 (36%) NORANCHF patients. Since improved P&S in RANCHF patients seemed independent of improved brain natriuretic peptide and impedance cardiography (BioZ) measurements, 5 day RAN was given to 30 subjects without CHF but with high SB or CAN. P&S improved in 90% of these subjects. Conclusions. RAN improves unfavorable P&S activity in CHF possibly by a direct effect upon autonomic sodium channels.


Cardiovascular autonomic neuropathy, Congestive heart failure, Major adverse cardiac events, Parasympathetic function, Patient outcomes, Ranolazine, Sympathetic function


Financial support: No grants or funding have been received for this study.



Published Online

September 23, 2014


Gary L. Murray Director, The Heart and Vascular Institute 7205 Wolf River Blvd Germantown TN, 38138, USA

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