Departamento de Cardiologia, Hospital Estadual de Erzincan, Erzincan.
Arq Bras Cardiol. 2012 Jul;99(1):659-64. doi: 10.1590/s0066-782x2012005000055. Epub 2012 Jun 26.
Levosimendan is known with its two-sided effects of strengthening myofibril contraction without increasing myocardial oxygen demand. Anemia is a deteriorating situation that causes increase of drug dosing in patients with heart failure.
In this study, we compared the effectiveness of levosimendan treatment in decompensated heart failure patients with or without anemia.
Twenty-three anemic patients having class 3 or 4 heart failure according to New York Heart Association (NYHA) and an ejection fraction of below 35% were included to the study. Another 23 patients with the same cardiac diagnosis but without anemia served as control group. Twenty-four hours levosimendan treatment was added to the traditional heart failure treatment of these patients. Samples were taken to measure serum tumor necrotizing factor alpha (TNF-alpha), aminoterminal pro-brain natriuretic peptide (NT-proBNP) and matrix metalloproteinase-1 (MMP-1) levels before and after the administration.
There was no significant difference between serum TNF-alpha and MMP-1 levels before and after the treatment (p>0.05). Although NT-proBNP level decreased in both groups after the treatment this was not statistically significant (p=0.531 and p=0.913 for anemia and control groups respectively). Significant restoration of functional capacity was seen in both groups assessed according to NYHA (p<0.001 and p=0.001 for anemia and control groups respectively).
Levosimendan treatment shows similar effects in heart failure patients with anemia to that of patients without anemia. However, the early effect of this treatment on TNF-alpha, NT-proBNP and MMP-1 levels is not evident. It provides significant improvement in functional capacity without influence from anemia.
左西孟旦具有增强肌丝收缩而不增加心肌需氧量的双向作用。贫血是一种恶化的情况，会导致心力衰竭患者的药物剂量增加。
本研究比较了左西孟旦治疗伴有或不伴有贫血的心力衰竭失代偿患者的疗效。
根据纽约心脏协会（NYHA）分级标准，将 23 名贫血且射血分数<35%的 3 或 4 级心力衰竭患者纳入研究。另 23 名具有相同心脏诊断但不贫血的患者作为对照组。对这些患者给予传统心力衰竭治疗的同时，给予 24 小时左西孟旦治疗。在治疗前后采集样本，以测量血清肿瘤坏死因子-α（TNF-α）、氨基末端脑钠肽前体（NT-proBNP）和基质金属蛋白酶-1（MMP-1）水平。
治疗前后血清 TNF-α和 MMP-1 水平无显著差异（p>0.05）。尽管两组治疗后 NT-proBNP 水平均降低，但无统计学意义（p=0.531 和 p=0.913，分别为贫血组和对照组）。根据 NYHA 评估，两组的功能能力均有显著恢复（p<0.001 和 p=0.001，分别为贫血组和对照组）。
左西孟旦治疗贫血和非贫血心力衰竭患者的疗效相似。然而，这种治疗对 TNF-α、NT-proBNP 和 MMP-1 水平的早期作用并不明显。它可显著改善功能能力，不受贫血影响。
