Department of Respiratory Medicine, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China.
State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China.
Life Sci. 2017 Sep 1;184:30-36. doi: 10.1016/j.lfs.2017.07.001. Epub 2017 Jul 8.
Right heart failure (RHF), which is caused by a variety of heart and lung diseases, has a high morbidity and mortality rate. Levosimendan is a cardiac inotropic drug and vasodilator. The effect of levosimendan on RHF remains unclear. We sought to evaluate the efficacy and safety of levosimendan in patients with acute RHF.
We systematically searched PubMed, Cochrane Library, EMBASE, and ClinicalTrials.gov to identify studies reporting the efficacy and safety of levosimendan for the treatment of RHF.
Ten trials, including 359 participants from 6 RCTs and 4 self-controlled trials, were evaluated. In the 6 RCTs, we found that patients treated with levosimendan for 24h showed a significant increase in tricuspid annular plane systolic excursion [1.53; 95% CI (0.54, 2.53); P=0.002] and ejection fraction [3.59; 95% CI (1.21, 5.98); P=0.003] as well as a significant reduction in systolic pulmonary artery pressure [-6.15; 95% CI (-9.29, -3.02); P=0.0001] and pulmonary vascular resistance [-39.48; 95% CI (-65.59, -13.38); P=0.003], whereas changes in mean pulmonary pressure were nonsignificant. Adverse events did not significantly differ between the two groups.
Our study shows that levosimendan exhibits short-term efficacy for treating RHF in patients with a variety of heart and lung diseases. Additional strict multicentre RCTs with long follow-up times and large sample sizes are required to further validate the efficacy and safety of this treatment.
右心衰竭（RHF）由多种心肺疾病引起，其发病率和死亡率均较高。左西孟旦是一种心脏正性肌力药物和血管扩张剂。左西孟旦治疗 RHF 的效果尚不清楚。我们旨在评估左西孟旦治疗急性 RHF 的疗效和安全性。
我们系统地检索了 PubMed、Cochrane 图书馆、EMBASE 和 ClinicalTrials.gov，以确定报告左西孟旦治疗 RHF 的疗效和安全性的研究。
纳入了 10 项研究，包括 6 项 RCT 和 4 项自身对照试验，共 359 名参与者。在 6 项 RCT 中，我们发现接受左西孟旦治疗 24 小时的患者三尖瓣环平面收缩期位移显著增加[1.53；95%置信区间（0.54，2.53）；P=0.002]和射血分数[3.59；95%置信区间（1.21，5.98）；P=0.003]，而收缩肺动脉压显著降低[-6.15；95%置信区间（-9.29，-3.02）；P=0.0001]和肺血管阻力[-39.48；95%置信区间（-65.59，-13.38）；P=0.003]，而平均肺动脉压的变化无统计学意义。两组之间的不良事件无显著差异。
我们的研究表明，左西孟旦在治疗多种心肺疾病引起的 RHF 患者中具有短期疗效。需要更多严格的多中心 RCT，具有更长的随访时间和更大的样本量，以进一步验证这种治疗的疗效和安全性。
