Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, Via Leonardo Bianchi 1, Naples 80100, Italy.
Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, Via Leonardo Bianchi 1, Naples 80100, Italy.
Heart Fail Clin. 2021 Oct;17(4):587-598. doi: 10.1016/j.hfc.2021.05.004. Epub 2021 Jul 22.
Patients with advanced heart failure suffer from severe and persistent symptoms, often not responding disease-modifying drugs, a marked limitation of functional capacity and poor quality of life that can ameliorate with inotropic drugs therapy. In small studies, pulsed infusions of classical inotropes (ie, dobutamine and milrinone) are associated with improvement in hemodynamic parameters and quality of life in patients with advanced heart failure. However, because of the adverse effects of these drugs, serious safety issues have been raised. Levosimendan is a calcium-sensitizing inodilators with a triple mechanism of action, whose infusion results in hemodynamic, neurohormonal, and inflammatory cytokine improvements in patients with chronic advanced HF. In addition, levosimendan has important pleiotropic effects, including protection of myocardial, renal, and liver cells from ischemia-reperfusion injury, and anti-inflammatory and antioxidant effects; these properties possibly make levosimendan an "organ protective" inodilator. In clinical trials and real-world evidence, infusion of levosimendan at fixed intervals is safe and effective in patients with advanced HF, alleviating clinical symptoms, reducing hospitalizations, and improving the quality of life. Therefore, the use of repeated doses of levosimendan could represent the therapy of choice as a bridge to transplant/left ventricular assist device implantation or as palliative therapy in patients with advanced heart failure.
患有晚期心力衰竭的患者会出现严重且持续的症状，通常对疾病修正药物没有反应，其功能能力显著受限，生活质量较差，而正性肌力药物治疗可改善这些情况。在小型研究中，经典正性肌力药物（如多巴酚丁胺和米力农）脉冲输注与晚期心力衰竭患者的血流动力学参数和生活质量的改善相关。然而，由于这些药物的不良反应，出现了严重的安全问题。左西孟旦是一种钙增敏型正性肌力血管扩张剂，具有三重作用机制，其输注可改善慢性晚期 HF 患者的血流动力学、神经激素和炎症细胞因子。此外，左西孟旦具有重要的多效性作用，包括保护心肌、肾脏和肝脏细胞免受缺血再灌注损伤，以及抗炎和抗氧化作用；这些特性可能使左西孟旦成为一种“器官保护”的正性肌力血管扩张剂。在临床试验和真实世界证据中，固定间隔输注左西孟旦在晚期心力衰竭患者中是安全有效的，可缓解临床症状，减少住院次数，并改善生活质量。因此，重复使用左西孟旦可能代表一种治疗选择，可作为移植/左心室辅助装置植入的桥梁，或作为晚期心力衰竭患者的姑息治疗。
