Paksoy Fatma, Ulaş Turgay, Tursun Irfan, Dal Mehmet Sinan, Oztekin Erkan, Borlu Fatih
Dr. Abdurrahman Yurtaslan Onkoloji Eğitim ve Araştırma Hastanesi, Medikal Onkoloji Kliniği, Ankara-Turkey.
Anadolu Kardiyol Derg. 2012 Feb;12(1):16-22. doi: 10.5152/akd.2012.004. Epub 2012 Jan 4.
We investigated the effect of intravenous levosimendan on QT dispersion compared with intravenous dobutamine in patients with acute decompensated heart failure.
This prospective cohort study included 38 patients who were admitted with acute decompensated heart failure (New York Heart Association functional class III-IV). Twenty-five patients (11 men, 14 women; mean age 70.5 ± 11.13 years) were treated with levosimendan infusion and 13 patients (5 men, 8 women; mean age 71.08 ± 6.86 years) were treated with dobutamine infusion. Intravenous levosimendan was administered with an initial bolus dose of 12 μg/kg for 10 min, followed by a continuous infusion of 0.1 μg/kg/min for 1 hour and 0.1 μg/kg/min 23 hours. Intravenous dobutamine was administered with a continuous dose of 10 μg/kg /min for 24 hours. Transthoracic echocardiography was performed and electrocardiograms were obtained before and after drug infusions. QTc dispersion was defined as the difference between the maximum and the minimum QT intervals and the value was corrected for heart rate. Chi-square test, Wilcoxon test and Mann-Whitney U tests were used for data analysis.
No significant differences were found before and after treatment of both levosimendan and dobutamine with respect to minimum QT intervals, maximum QT and QT dispersions. (Pretreatment and 24th hour values of levosimendan group were; 0.43 ± 0.04 s, 0.44 ± 0.04s; 0.49 ± 0.05s, 0.50 ± 0.05s; 0.06 ± 0.03s, 0.06 ± 0.03s; in dobutamine group values are - 0.39 ± 0.05 s, 0.41 ± 0.05s; 0.45 ± 0.05s, 0.48 ± 0.05s; 0.06 ± 0.04s, 0.06 ± 0.04s, respectively) (p>0.05). No side effects related to drugs were seen during follow-up in all two treatment groups.
Our results suggest that, therapeutic doses of levosimendan infusion do not have a significant effect on QT parameters - the predictors of arrhythmias-, in patients with decompensated heart failure when compared with dobutamine infusion.
我们研究了静脉注射左西孟旦与静脉注射多巴酚丁胺相比，对急性失代偿性心力衰竭患者QT离散度的影响。
这项前瞻性队列研究纳入了38例因急性失代偿性心力衰竭入院的患者（纽约心脏协会心功能分级III - IV级）。25例患者（11例男性，14例女性；平均年龄70.5±11.13岁）接受左西孟旦输注治疗，13例患者（5例男性，8例女性；平均年龄71.08±6.86岁）接受多巴酚丁胺输注治疗。静脉注射左西孟旦时，先给予12μg/kg的初始推注剂量，持续10分钟，随后以0.1μg/kg/min的速度持续输注1小时，再以0.1μg/kg/min的速度持续输注23小时。静脉注射多巴酚丁胺时，以10μg/kg/min的持续剂量输注24小时。在药物输注前后进行经胸超声心动图检查并记录心电图。QTc离散度定义为最大和最小QT间期之差，并根据心率进行校正。采用卡方检验、威尔科克森检验和曼 - 惠特尼U检验进行数据分析。
左西孟旦组和多巴酚丁胺组在治疗前后的最小QT间期、最大QT间期和QT离散度方面均未发现显著差异。（左西孟旦组治疗前和第24小时的值分别为：0.43±0.04秒，0.44±0.04秒；0.49±0.05秒，0.50±0.05秒；0.06±0.03秒，0.06±0.03秒；多巴酚丁胺组的值分别为 - 0.39±0.05秒，0.41±0.05秒；0.45±0.05秒，0.48±0.05秒；0.06±0.04秒，0.06±0.04秒）（p>0.05）。在两个治疗组的随访期间均未观察到与药物相关的副作用。
我们的结果表明，与多巴酚丁胺输注相比，治疗剂量的左西孟旦输注对失代偿性心力衰竭患者的QT参数（心律失常的预测指标）没有显著影响。
