Guarracino Fabio, Zima Endre, Pollesello Piero, Masip Josep
Dipartimento di Anestesia e Terapie Intensive, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
Cardiac Intensive Care, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
Eur Heart J Suppl. 2020 May;22(Suppl D):D3-D11. doi: 10.1093/eurheartj/suaa090. Epub 2020 May 15.
Acute heart failure (AHF) continues to be a substantial cause of illness and death, with in-hospital and 3-month mortality rates of 5% and 10%, respectively, and 6-month re-admission rates in excess of 50% in a range of clinical trials and registry studies; the European Society of Cardiology (ESC) Heart Failure Long-Term Registry recorded a 1-year death or rehospitalization rate of 36%. As regards the short-term treatment of AHF patients, evidence was collected in the ESC Heart Failure Long-Term Registry that intravenous (i.v.) treatments are administered heterogeneously in the critical phase, with limited reference to guideline recommendations. Moreover, recent decades have been characterized by a prolonged lack of successful innovation in this field, with a plethora of clinical trials generating neutral or inconclusive findings on long-term mortality effects from a multiplicity of short-term interventions in AHF. One of the few exceptions has been the calcium sensitizer and inodilator levosimendan, introduced 20 years ago for the treatment of acutely decompensated chronic heart failure. In the present review, we will focus on the utility of this agent in the wider context of i.v. inotropic and inodilating therapies for AHF and related pathologies.
急性心力衰竭（AHF）仍然是疾病和死亡的重要原因，在一系列临床试验和注册研究中，其住院死亡率和3个月死亡率分别为5%和10%，6个月再入院率超过50%；欧洲心脏病学会（ESC）心力衰竭长期注册研究记录的1年死亡或再住院率为36%。关于AHF患者的短期治疗，ESC心力衰竭长期注册研究收集的证据表明，在关键阶段，静脉注射（i.v.）治疗的使用存在异质性，对指南建议的参考有限。此外，近几十年来，该领域长期缺乏成功的创新，大量临床试验对AHF多种短期干预措施的长期死亡率影响得出了中性或不确定结论。少数例外之一是钙增敏剂和血管扩张性正性肌力药左西孟旦，它于20年前被引入用于治疗急性失代偿性慢性心力衰竭。在本综述中，我们将重点探讨该药物在AHF及相关病症的静脉注射正性肌力和血管扩张治疗这一更广泛背景下的效用。
