García-González Martín J, Jorge-Pérez Pablo, Jiménez-Sosa Alejandro, Acea Antonio Barragán, Lacalzada Almeida Juan B, Ferrer Hita Julio J
Acute Cardiac Care Unit, Department of Cardiology, Hospital Universitario de Canarias - Servicio Canario de la Salud, Tenerife, Spain.
Research Unit, Hospital Universitario de Canarias, Ctra. La Cuesta - Taco, San Cristobal de La Laguna, Sta. Cruz de Tenerife, Spain.
Cardiovasc Ther. 2015 Aug;33(4):193-9. doi: 10.1111/1755-5922.12132.
To study the hemodynamic effect of levosimendan administration in acute heart failure patients with severe aortic stenosis (AS) and reduced left ventricular ejection fraction (LVEF).
Hemodynamic response to 24 h intravenous levosimendan infusion (0.1 μg/kg/min without a loading dose) in patients with severe AS (aortic valve area ≤1 cm(2) , time-velocity integral between left ventricular out-flow tract and aortic valve <0.25), reduced LVEF (≤40%), and a depressed cardiac index (CI) <2.2 L/min/m(2) was determined in a sequential group of nine patients aged 76 ± 10 years (5 men).
Baseline mean ejection fraction was 33 ± 0.7%; mean aortic valve area was 0.37 ±0.11 cm(2) /m(2) ; peak and mean gradients of 63.6 ± 20.53 and 36.7 ± 12.62 mmHg, respectively; and mean CI was 1.65 ± 0.20 L/min/m(2) . At 6 and 12 h of levosimendan therapy, mean CI had increased to 2.00 ± 0.41 L/min/m(2) (P = 0.02) and 2.17 ± 0.40 L/min/m(2) (P = 0.01), respectively. At 24 h, mean CI had increased further to 2.37 ± 0.49 L/min/m(2) (P = 0.01). A significant beneficial effect was also observed in pulmonary capillary wedge pressure, pulmonary artery mean pressure, central venous pressure, systemic vascular resistances, pulmonary vascular resistances, stroke volume index, left ventricular stroke work index. NTproBNP levels decreased at 24 h of levosimendan treatment. Levosimendan infusion was also well tolerated. Five patients subsequently underwent aortic valve surgery replacement. One died (of postoperative multiorgan failure). At 30 days, overall survival was 75%.
Levosimendan administration improves hemodynamic parameters in critically ill patients with severe AS and reduced LVEF. In our study, it provides a safe and effective bridge to aortic-valve replacement or oral vasodilator therapy in surgical contraindicated patients. A controlled study is needed to confirm these preliminary findings.
研究左西孟旦对重度主动脉瓣狭窄（AS）且左心室射血分数（LVEF）降低的急性心力衰竭患者的血流动力学影响。
对9例年龄76±10岁（5例男性）的患者进行序贯研究，这些患者患有重度AS（主动脉瓣面积≤1cm²，左心室流出道与主动脉瓣之间的时间速度积分<0.25）、LVEF降低（≤40%）且心脏指数（CI）降低<2.2L/min/m²，测定其对24小时静脉输注左西孟旦（0.1μg/kg/min，无负荷剂量）的血流动力学反应。
基线平均射血分数为33±0.7%；平均主动脉瓣面积为0.37±0.11cm²/m²；峰值和平均压力阶差分别为63.6±20.53和36.7±12.62mmHg；平均CI为1.65±0.20L/min/m²。在左西孟旦治疗6小时和12小时时，平均CI分别增加至2.00±0.41L/min/m²（P=0.02）和2.17±0.40L/min/m²（P=0.01）。在24小时时，平均CI进一步增加至2.37±0.49L/min/m²（P=0.01）。在肺毛细血管楔压、肺动脉平均压、中心静脉压、全身血管阻力、肺血管阻力、每搏量指数、左心室每搏功指数方面也观察到显著的有益效果。左西孟旦治疗24小时时NTproBNP水平下降。左西孟旦输注耐受性良好。5例患者随后接受了主动脉瓣置换手术。1例死亡（死于术后多器官功能衰竭）。在30天时，总生存率为75%。
左西孟旦给药可改善重度AS且LVEF降低的危重症患者的血流动力学参数。在我们的研究中，它为手术禁忌患者的主动脉瓣置换或口服血管扩张剂治疗提供了安全有效的桥梁。需要进行对照研究来证实这些初步发现。
