Mebazaa A, Erhardt L
Department of Anaesthesiology and Critical Care Medicine, Lariboisière Hospital, Paris, France.
Int J Clin Pract. 2003 Jun;57(5):410-6.
Levosimendan is a new agent for the treatment of acute heart failure. Levosimendan acts via complementary mechanisms; it enhances contractility by sensitising cardiac myofilaments to calcium and dilates blood vessels by opening ATP-dependent potassium channels. In contrast to traditional inotropes (beta-agonists or phosphodiesterase inhibitors), levosimendan does not raise myocyte calcium levels and is therefore less likely to elicit arrhythmias or to impair diastolic relaxation. The clinical efficacy of levosimendan is supported by four key clinical studies, including more than 900 patients hospitalised for cardiac decompensation due to acutely worsened chronic heart failure or to heart failure following myocardial infarction. When given as short-term therapy, levosimendan enhances cardiac output, reduces systemic vascular resistance and lowers pulmonary capillary wedge pressure. At 31 days post-treatment, mortality rates were halved in decompensated chronic heart failure patients who received levosimendan, compared with those on dobutamine--an advantage sustained at 180 days. Similar survival gains were observed among acute failure patients treated with levosimendan following myocardial infarction. With its substantial haemodynamic and survival benefits, levosimendan is well suited to be part of routine management for patients with acutely decompensated heart failure.
左西孟旦是一种用于治疗急性心力衰竭的新型药物。左西孟旦通过多种互补机制发挥作用；它通过使心肌肌丝对钙敏感来增强心肌收缩力，并通过开放ATP依赖性钾通道来扩张血管。与传统的强心药（β受体激动剂或磷酸二酯酶抑制剂）不同，左西孟旦不会提高心肌细胞内的钙水平，因此引发心律失常或损害舒张期松弛的可能性较小。四项关键临床研究证实了左西孟旦的临床疗效，这些研究纳入了900多名因慢性心力衰竭急性加重或心肌梗死后心力衰竭而住院的心衰失代偿患者。短期治疗时，左西孟旦可增加心输出量，降低全身血管阻力并降低肺毛细血管楔压。治疗后31天，接受左西孟旦治疗的失代偿慢性心力衰竭患者的死亡率与接受多巴酚丁胺治疗的患者相比减半——这种优势在180天时仍持续存在。在心肌梗死后接受左西孟旦治疗的急性心力衰竭患者中也观察到了类似的生存获益。鉴于其显著的血流动力学和生存益处，左西孟旦非常适合作为急性失代偿性心力衰竭患者常规治疗的一部分。
