Ranolazine Improves Autonomic Balance In Heart Failure When Added To Guideline-Driven Therapy


The effect of ranolazine (RAN) on cardiac autonomic balance in congestive heart failure (CHF) was studied.


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.


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.


RAN improves unfavorable P&S activity in CHF possibly by a direct effect upon autonomic sodium channels.         Murray GL, Colombo J. Ranolazine improves autonomic balance in heart failure when added to guideline driven therapy.  Heart International 2014 ; 9 (2): 59-65; published online 9/23/2014 6:53:43 AM DOI: 10.5301/heartint.5000215. https://pubmed.ncbi.nlm.nih.gov/27004100/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4774937/ https://journals.sagepub.com/doi/epub/10.5301/heartint.5000215  
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