De Luca Leonardo, Proietti Paola, Celotto Annalisa, Bucciarelli-Ducci Chiara, Benedetti Giulia, Di Roma Angelo, Sardella Gennaro, Genuini Igino, Fedele Francesco
Department of Cardiovascular and Respiratory Sciences, La Sapienza University, Rome, Italy.
Am Heart J. 2005 Sep;150(3):563-8. doi: 10.1016/j.ahj.2004.10.013.
Positive inotropic agents may be associated with increasing myocardial ischemia or malignant arrhythmias. Levosimendan, a new calcium sensitizer, with its little effect on myocardial oxygen demand is better tolerated by patients with acute coronary syndromes. We evaluated the acute effects of levosimendan on hemodynamics and coronary flow velocities in patients with left ventricular (LV) dysfunction undergoing percutaneous coronary interventions (PCIs) for an acute myocardial infarction (AMI).
Patients with AMI and LV dysfunction undergoing primary PCI were randomized to intravenous infusion of levosimendan (10 minutes bolus with 12 microg/kg followed by 0.1 microg/kg per minute for 24 hours) or placebo, 10 minutes after a primary PCI. Evaluation of hemodynamics and of coronary flow reserve (CFR) were performed at baseline and after bolus.
Twenty-six consecutive patients (mean age 57 +/- 5.4 years, 18 males) were included into the study. At baseline, mean values of hemodynamics and coronary flow velocities were comparable between groups. After bolus, patients with levosimendan (n = 12) showed a significant decrease of pulmonary capillary wedge pressure (from 24 to 19 mm Hg) and a significant increase of cardiac index (from 1.8 to 2.4 L/m2 per minute) resulting in a significant decrease of systemic vascular resistance (from 1366 to 1075 [dyne . s]/cm2). Moreover, CFR on infarct-related artery and on reference vessel significantly improved in patients treated with levosimendan (from 1.6 to 2.0 and from 2.1 to 2.4, respectively). On the other hand, no statistically significant changes have been observed in the placebo group (n = 14).
Levosimendan, given intravenously after a PCI procedure in patients with AMI and LV dysfunction, significantly improves hemodynamics and CFR, compared with placebo.
正性肌力药物可能会增加心肌缺血或恶性心律失常的发生风险。左西孟旦作为一种新型钙增敏剂，对心肌氧需求影响较小，急性冠状动脉综合征患者对其耐受性较好。我们评估了左西孟旦对因急性心肌梗死（AMI）接受经皮冠状动脉介入治疗（PCI）的左心室（LV）功能不全患者的血流动力学和冠状动脉血流速度的急性影响。
将因AMI和LV功能不全接受直接PCI的患者在直接PCI后10分钟随机分为静脉输注左西孟旦组（先静脉推注12μg/kg，持续10分钟，随后以0.1μg/kg每分钟的速度持续输注24小时）或安慰剂组。在基线和推注后评估血流动力学和冠状动脉血流储备（CFR）。
连续26例患者（平均年龄57±5.4岁，18例男性）纳入研究。基线时，两组间血流动力学和冠状动脉血流速度的平均值具有可比性。推注后，左西孟旦组（n = 12）患者的肺毛细血管楔压显著降低（从24mmHg降至19mmHg），心脏指数显著升高（从1.8L/（m²·分钟）升至2.4L/（m²·分钟）），导致全身血管阻力显著降低（从1366降至1075 [达因·秒]/cm²）。此外，左西孟旦治疗组患者梗死相关动脉和参照血管的CFR显著改善（分别从1.6升至2.0和从2.1升至2.4）。另一方面，安慰剂组（n = 14）未观察到统计学上的显著变化。
对于AMI和LV功能不全患者，PCI术后静脉给予左西孟旦与安慰剂相比，能显著改善血流动力学和CFR。
