左西孟旦对缺血性心肌病患者心室动脉耦联的影响。

Effect of levosimendan on ventriculo-arterial coupling in patients with ischemic cardiomyopathy.

作者信息

Guarracino F, Cariello C, Danella A, Doroni L, Lapolla F, Stefani M, Baldassarri R, Vullo C

机构信息

Cardiothoracic Anaesthesia and Intensive Care Unit, Cardiothoracic Department, University Hospital of Pisa, Italy.

出版信息

Acta Anaesthesiol Scand. 2007 Oct;51(9):1217-24. doi: 10.1111/j.1399-6576.2007.01428.x.

DOI:10.1111/j.1399-6576.2007.01428.x

PMID:17850562

Abstract

BACKGROUND

Levosimendan, a novel calcium sensitizer, enhances myocardial contractility without affecting intracellular calcium concentration. It also dilates peripheral arterial vessels by acting on ATP-dependent K(+) channels. Ventriculo-arterial coupling, the relationship between myocardial contractility and the arterial system, describes the efficiency of the cardiovascular system by analysing the relationship between myocardial contractility expressed by ventricular elastance (E(es)) and arterial elastance (E(a)). The aim of this prospective clinical investigation was to evaluate the effects of levosimendan on ventriculo-arterial coupling in patients with ischemic cardiomyopathy.

METHODS

Fifteen patients with stable angina and left ventricular dysfunction underwent elective coronary surgery. Before surgery started, ventriculo-arterial coupling and several variables of cardiovascular performance were assessed by invasive monitoring and transoesophageal echocardiography before and after administration of levosimendan (12 mug/kg bolus) in coronary patients under general anesthesia.

RESULTS

The cardiac index and ejection fraction increased significantly [from 1.92 +/- 0.4 to 2.1 +/- 0.4 l/min/m(2) (P = 0.0004) and from 31% +/- 6 to 40% +/- 9 (P = 0.001), respectively], while mean arterial pressure and systemic vascular resistances decreased significantly [from 83 +/- 10 to 72 +/- 5 mmHg (P = 0.0016) and from 997 +/- 341 to 855 +/- 324 dyne s/cm(5) (P = 0.0002), respectively]. After administration of levosimendan, E(a) decreased significantly (from 4.3 +/- 1.8 to 3.2 +/- 1.3 mmHg/ml/m(2), P= 0.005), while E(es) significantly increased (from 2.8 +/- 1.6 to 4.4 +/- 2.3 mmHg/ml/m(2), P= 0.05); as a result, E(a)/E(es) decreased significantly (from 1.76 +/- 1 to 0.83 +/- 0.2, P= 0.002).

CONCLUSION

Levosimendan improves ventriculo-arterial coupling and cardiovascular performance in coronary patients with left ventricular dysfunction by enhancing myocardial contractility and reducing arterial elastance.

摘要

背景

左西孟旦是一种新型钙增敏剂，可增强心肌收缩力而不影响细胞内钙浓度。它还通过作用于ATP依赖性钾通道扩张外周动脉血管。心室 - 动脉耦联，即心肌收缩力与动脉系统之间的关系，通过分析心室弹性（E(es)）所表达的心肌收缩力与动脉弹性（E(a)）之间的关系来描述心血管系统的效率。这项前瞻性临床研究的目的是评估左西孟旦对缺血性心肌病患者心室 - 动脉耦联的影响。

方法

15例稳定型心绞痛伴左心室功能不全的患者接受了择期冠状动脉手术。在手术开始前，通过有创监测和经食管超声心动图在全身麻醉下的冠状动脉疾病患者中评估左西孟旦（12μg/kg静脉推注）给药前后的心室 - 动脉耦联和心血管功能的几个变量。

结果

心脏指数和射血分数显著增加[分别从1.92±0.4增至2.1±0.4 l/min/m²（P = 0.0004）和从31%±6增至40%±9（P = 0.001）]，而平均动脉压和全身血管阻力显著降低[分别从83±10降至72±5 mmHg（P = 0.0016）和从997±341降至855±324达因·秒/cm⁵（P = 0.0002）]。给予左西孟旦后，E(a)显著降低（从4.3±1.8降至3.2±1.3 mmHg/ml/m²，P = 0.005），而E(es)显著增加（从2.8±1.6增至4.4±2.3 mmHg/ml/m²，P = 0.05）；结果，E(a)/E(es)显著降低（从1.76±1降至0.83±0.2，P = 0.002）。