3rd Cardiology Department, University of Athens Medical School, Athens, Greece.
Int J Cardiol. 2012 Sep 6;159(3):225-9. doi: 10.1016/j.ijcard.2011.03.013. Epub 2011 Apr 8.
Inotrope treatment is often necessary in refractory to optimal management end stage heart failure, when signs of end-organ hypoperfusion appear. The effect of specific inotropes on patient outcome remains controversial. The aim of the study was to compare the effect of levosimendan versus dobutamine, alone or in combination with levosimendan, on the outcome of end-stage heart failure patients, requiring inotropic therapy.
We studied 63 patients in NYHA class IV, refractory to optimal medical therapy, recently hospitalized for cardiac decompensation and stabilized by an intravenous inotrope. They were randomly assigned to intermittent infusions of either a) dobutamine, 10mg/kg/min, versus b) levosimendan, 0.3mg/kg/min, versus c) dobutamine, 10mg/kg/min+levosimendan 0.2 mg/kg/min, each administered weekly, for 6h, over a 6-month period. All patients received amiodarone, 400 mg/day, to suppress the proarrhythmic effects of the inotropes. Baseline characteristics of the 3 groups were similar. At 6 months, survival free from death or urgent left ventricular device implantation was 80% in the levosimendan, 48% in the dobutamine (P=0.037 versus levosimendan), and 43% in the levosimendan+dobutamine (P=0.009 versus levosimendan) group. At 3months, NYHA class improved significantly in all 3 groups, whereas pulmonary capillary wedge pressure decreased (27 ± 4 to 19 ± 8 mmHg, P=0.008) and cardiac index increased (1.5 ± 0.3 to 2.1 ± 0.3 l/min/m(2), P=0.002) significantly only in patients assigned to levosimendan.
In patients with refractory end-stage heart failure, intermittent administration of levosimendan conferred survival and hemodynamic benefits in comparison to a regimen of intermittent infusions of dobutamine, alone or in combination with levosimendan.
在出现终末器官低灌注迹象时，对于难治性最佳治疗的终末期心力衰竭患者，通常需要使用正性肌力药物治疗。目前对于特定正性肌力药物对患者预后的影响仍存在争议。本研究旨在比较左西孟旦、多巴酚丁胺单独或联合左西孟旦对需要正性肌力药物治疗的终末期心力衰竭患者的疗效。
我们研究了 63 例 NYHA 分级 IV 级、对最佳药物治疗无反应、因心脏失代偿而新近住院且经静脉正性肌力药物稳定的患者。他们被随机分为三组，分别接受下列治疗：（a）多巴酚丁胺，10mg/kg/min；（b）左西孟旦，0.3mg/kg/min；（c）多巴酚丁胺，10mg/kg/min+左西孟旦，0.2mg/kg/min，每周各治疗 6 小时，持续 6 个月。所有患者均接受胺碘酮，400mg/天，以抑制正性肌力药物的致心律失常作用。三组患者的基线特征相似。6 个月时，左西孟旦组的无死亡或紧急左心室装置植入生存率为 80%，多巴酚丁胺组为 48%（P=0.037 与左西孟旦相比），左西孟旦+多巴酚丁胺组为 43%（P=0.009 与左西孟旦相比）。3 个月时，所有三组患者的 NYHA 分级均显著改善，而肺毛细血管楔压降低（27±4 至 19±8mmHg，P=0.008），心指数升高（1.5±0.3 至 2.1±0.3l/min/m2，P=0.002），仅在接受左西孟旦治疗的患者中观察到。
在难治性终末期心力衰竭患者中，与多巴酚丁胺单独或联合左西孟旦间歇输注方案相比，间歇给予左西孟旦可带来生存和血液动力学获益。
