左西孟旦对晚期心力衰竭患者冠状动脉血流及心脏功能的影响。

Effects of levosimendan on coronary artery flow and cardiac performance in patients with advanced heart failure.

作者信息

Ikonomidis Ignatios, Parissis John T, Paraskevaidis Ioannis, Kourea Kallirrhoe, Bistola Vasiliki, Lekakis John, Filippatos Gerasimos, Kremastinos Dimitrios Th

机构信息

Second Cardiology Department and Heart Failure Unit, University of Athens Medical School, Attikon University Hospital, Athens, Greece.

出版信息

Eur J Heart Fail. 2007 Dec;9(12):1172-7. doi: 10.1016/j.ejheart.2007.10.002. Epub 2007 Nov 19.

DOI:10.1016/j.ejheart.2007.10.002

PMID:18062901

Abstract

BACKGROUND

Levosimendan has inotropic and vasodilatory effects. We investigated the effects of levosimendan on coronary flow and associated changes in neurohormonal activation and cardiac performance in patients with advanced heart failure.

METHODS

Forty-two patients with NYHA III-IV and a left ventricular ejection fraction (EF) 25+/-6%, were randomised to levosimendan 0.1 microg/kg/min (n=21) or placebo for 24 h. Before and 24 h after each treatment, we assessed: the maximal velocity (Vmax), time integral (VTI) and deceleration time (DT) of the diastolic coronary flow wave (CF) in LAD using transthoracic Doppler echocardiography, pulmonary artery systolic pressure by Doppler echocardiography, E/E' ratio using Doppler imaging of mitral inflow velocity, tissue Doppler imaging of the mitral annulus and B-type natriuretic peptide (BNP) levels.

RESULTS

By ANOVA, there was a greater increase in CF-Vmax (43+/-23 vs.25+/-8 cm/s), CF-DT (904+/-250 vs. 667+/-151 ms), and EF and a greater decrease in BNP, pulmonary artery systolic pressure and E/E? after levosimendan than after placebo (p<0.05). Compared to baseline, the percent changes in CF-VTI were related to the concomitant changes in EF, E/E?, and BNP after treatment with levosimendan (r=0.69, r=?0.51 and r=?0.80, p<0.05 respectively).

CONCLUSION

Treatment with levosimendan improves coronary flow and microcirculation in parallel with an improvement in cardiac performance and neurohormonal activation in patients with advanced heart failure.

摘要

背景

左西孟旦具有正性肌力和血管舒张作用。我们研究了左西孟旦对晚期心力衰竭患者冠状动脉血流的影响以及神经激素激活和心脏功能的相关变化。

方法

42例纽约心脏协会（NYHA）心功能III-IV级、左心室射血分数（EF）为25±6%的患者被随机分为两组，分别接受0.1微克/千克/分钟的左西孟旦治疗（n = 21）或安慰剂治疗24小时。在每次治疗前和治疗后24小时，我们评估了：使用经胸多普勒超声心动图测量左前降支（LAD）舒张期冠状动脉血流波（CF）的最大速度（Vmax）、时间积分（VTI）和减速时间（DT），使用多普勒超声心动图测量肺动脉收缩压，使用二尖瓣流入速度的多普勒成像、二尖瓣环组织多普勒成像和B型利钠肽（BNP）水平评估E/E'比值。

结果

通过方差分析，与安慰剂组相比，左西孟旦组的CF-Vmax（43±23 vs.25±8厘米/秒）、CF-DT（904±250 vs. 667±151毫秒）和EF增加更明显，BNP、肺动脉收缩压和E/E'降低更明显（p<0.05）。与基线相比，左西孟旦治疗后CF-VTI的百分比变化与EF、E/E'和BNP的伴随变化相关（r = 0.69、r = -0.51和r = -0.80，p均<0.05）。