De Luca Leonardo, Sardella Gennaro, Proietti Paola, Battagliese Alessandro, Benedetti Giulia, Di Roma Angelo, Fedele Francesco
Department of Cardiovascular and Respiratory Sciences, La Sapienza University, Rome, Italy.
J Am Soc Echocardiogr. 2006 Feb;19(2):172-7. doi: 10.1016/j.echo.2005.08.016.
Levosimendan is a new Ca-sensitizing drug with combined positive inotropic and vasodilatory effects that offers new therapeutic possibilities in patients with severe heart failure. Compared with other inotropic agents, animal studies demonstrated that levosimendan does not impair left ventricular diastolic function.
We sought to evaluate the effects of levosimendan on left ventricular diastolic function, using conventional transmitral Doppler and Doppler tissue imaging parameters, in patients with anterior acute myocardial infarction undergoing primary angioplasty.
After a successful primary angioplasty, we randomized 52 consecutive patients with anterior acute myocardial infarction to levosimendan or placebo infusion and analyzed the diastolic function using conventional transmitral Doppler flow and Doppler tissue imaging at mitral annulus.
At 24 hours after the index intervention, patients treated with levosimendan (n = 26) showed a significant reduction of the isovolumetric relaxation time (114.6 +/- 15.1-69.2 +/- 5.6 milliseconds; P = .001) and the ratio between the early diastolic flow and early tissue velocity (E/E') (21.4 +/- 10.7-12.8 +/- 7.3; P = .04), and a significant increase of the ratio between the early and late diastolic flow (E/A) (0.86 +/- 0.33-1.52 +/- 0.88; P = .03) and E' (6.4-7.9 cm/s; P = .001). On the other hand, only a significant increase in E/A ratio (0.97 +/- 0.32-1.64 +/- 0.51; P = .002) was observed in the placebo group (n = 26).
Levosimendan, after primary angioplasty in patients with anterior acute myocardial infarction, appears to improve the Doppler echocardiographic parameters of left ventricular diastolic function.
左西孟旦是一种新型的钙增敏药物，具有正性肌力和血管舒张的联合作用，为重度心力衰竭患者提供了新的治疗选择。与其他正性肌力药物相比，动物研究表明左西孟旦不会损害左心室舒张功能。
我们试图使用传统的经二尖瓣多普勒和多普勒组织成像参数，评估左西孟旦对接受直接血管成形术的前壁急性心肌梗死患者左心室舒张功能的影响。
在成功进行直接血管成形术后，我们将52例连续的前壁急性心肌梗死患者随机分为接受左西孟旦或安慰剂输注组，并使用传统的经二尖瓣多普勒血流和二尖瓣环处的多普勒组织成像分析舒张功能。
在指数干预后24小时，接受左西孟旦治疗的患者（n = 26）等容舒张时间显著缩短（114.6±15.1 - 69.2±5.6毫秒；P = .001），舒张早期血流与早期组织速度之比（E/E'）降低（21.4±10.7 - 12.8±7.3；P = .04），舒张早期与晚期血流之比（E/A）（0.86±0.33 - 1.52±0.88；P = .03）和E'（6.4 - 7.9厘米/秒；P = .001）显著增加。另一方面，安慰剂组（n = 26）仅观察到E/A比值显著增加（0.97±0.32 - 1.64±0.51；P = .002）。
在前壁急性心肌梗死患者进行直接血管成形术后，左西孟旦似乎可改善左心室舒张功能的多普勒超声心动图参数。
Zotero 插件