Palmerini Elisabetta, Söderberg Stefan, Mondillo Sergio, Favilli Roberto, Lunghetti Stefano
Department of Cardiovascular Diseases, Siena University Hospital , Siena , Italy.
Acute Card Care. 2015 Mar;17(1):14-9. doi: 10.3109/17482941.2015.1005102. Epub 2015 Mar 25.
Levosimendan is a calcium sensitizer and K(+)-ATP channel opener with inotropic and vasodilatatory effects irrespective of myocardial oxygen consumption, used for treatment of heart failure (HF). A loading dose is usually given by infusion for 12 h; however, profound lowering of blood pressure often disrupts or prolongs the infusion. The aim of this study was to assess clinical, biochemical and myocardial differences between different regimes of levosimendan therapy, with or without loading dose, and compared to standard therapy in heart failure.
Fifty-seven patients (mean age ± SD: 60.9 ± 9.3 years, 45 males) with HF, New York Heart Association (NYHA) III-IV, reduced left ventricular ejection fraction (LVEF) were included. Twenty patients (NB group) were given levosimendan without loading dose, 14 patients (B group) were given levosimendan with loading dose, and 23 patients (C group) were given standard therapy. Clinical, biochemical and echocardiographic characteristics at baseline and one week after treatment were evaluated.
Groups were similar at baseline. After one week NHYA class (P < 0.001), NT pro-BNP (P < 0.001), LVEF (P = 0.045), E/A (P = 0.048) E/e' (P < 0.001), and PAPs (P < 0.001) decreased. DT (P = 0.011) and TAPSE (P = 0.035) increased in all groups.
Levosimendan, as well as standard therapy, improves myocardial function and symptoms of HF, irrespective of the loading dose administration. Treatment options for patients with end-stage heart failure refractory to conventional medical therapy are limited. Inotropic drugs play an important role in heart failure (HF).
左西孟旦是一种钙增敏剂和钾离子通道开放剂，具有正性肌力和血管舒张作用，且不依赖心肌耗氧量，用于治疗心力衰竭（HF）。通常通过静脉输注12小时给予负荷剂量；然而，血压大幅下降常常会中断或延长输注过程。本研究的目的是评估左西孟旦治疗不同方案（有或无负荷剂量）之间的临床、生化和心肌差异，并与心力衰竭的标准治疗进行比较。
纳入57例纽约心脏协会（NYHA）III-IV级、左心室射血分数（LVEF）降低的心力衰竭患者（平均年龄±标准差：60.9±9.3岁，45例男性）。20例患者（NB组）给予无负荷剂量的左西孟旦，14例患者（B组）给予有负荷剂量的左西孟旦，23例患者（C组）给予标准治疗。评估基线和治疗一周后的临床、生化和超声心动图特征。
各组在基线时相似。一周后，NYHA分级（P<0.001）、N末端脑钠肽前体（NT pro-BNP）（P<0.001）、LVEF（P=0.045）、E/A（P=0.048）、E/e'（P<0.001）和肺动脉压（PAPs）（P<0.001）均降低。所有组的减速时间（DT）（P=0.011）和三尖瓣环平面收缩期位移（TAPSE）（P=0.035）均增加。
无论是否给予负荷剂量，左西孟旦以及标准治疗均可改善心肌功能和心力衰竭症状。对于传统药物治疗难治的终末期心力衰竭患者，治疗选择有限。正性肌力药物在心力衰竭（HF）中起重要作用。
