Qu Chao, Feng Wei, Zhao Qi, Liu Qi, Luo Xing, Wang Gang, Sun Meng, Yao Zhibo, Sun Yufei, Hou Shenglong, Zhao Chunyang, Zhang Ruoxi, Qu Xiufen
Department of Cardiology, Heilongjiang Provincial People's Hospital, Harbin, China.
Department of Cardiology, 1st Affiliated Hospital of Harbin Medical University, Harbin, China.
Front Med (Lausanne). 2022 Mar 4;9:778620. doi: 10.3389/fmed.2022.778620. eCollection 2022.
Acute decompensated right heart failure (RHF) in chronic precapillary pulmonary hypertension is often typified by a swiftly progressive syndrome involving systemic congestion. This results from the impairment of the right ventricular filling and/or a reduction in the flow output of the right ventricle, which has been linked to a dismal prognosis of short duration. Despite this, there are limited therapeutic data regarding these acute incidents. This study examined the effect of levosimendan on acute decompensated RHF in patients with connective tissue disease-associated pulmonary arterial hypertension (CTD-PAH).
This retrospective study included 87 patients with confirmed CTD-PAH complicated acute decompensated RHF between November 2015 and April 2021. We collected biological, clinical, and demographic data, as well as therapy data, from patients with acute decompensated RHF who required levosimendan treatment in the cardiac care unit (CCU) for CTD-PAH. The patients were divided into two groups according to the levosimendan treatment. Patient information between the two groups was systematically compared in hospital and at follow-up.
Oxygen saturation of mixed venose blood (SvO), estimated glomerular filtration rate (eGFR), 24-h urine output, and tricuspid annular plane systolic excursion (TAPSE) were found to be considerably elevated in the levosimendan cohort compared with the control cohort. Patients in the levosimendan cohort exhibited considerably reduced levels of C-reactive protein (CRP), white blood cell (WBC), troponin I, creatinine, NT-proBNP, and RV diameter compared with those in the control cohort. A higher survival rate was observed in the levosimendan cohort.
Levosimendan treatment could effectively improve acute decompensated RHF and systemic hemodynamics in CTD-PAH patients, with positive effects on survival in hospital and can, therefore, be considered as an alternative treatment option for improving clinical short-term outcomes.
慢性毛细血管前性肺动脉高压所致急性失代偿性右心衰竭（RHF）通常表现为一种迅速进展的、累及体循环淤血的综合征。这是由右心室充盈受损和/或右心室心输出量减少导致的，与短期的不良预后相关。尽管如此，关于这些急性事件的治疗数据有限。本研究探讨了左西孟旦对结缔组织病相关性肺动脉高压（CTD-PAH）患者急性失代偿性RHF的影响。
这项回顾性研究纳入了2015年11月至2021年4月期间确诊为CTD-PAH并伴有急性失代偿性RHF的87例患者。我们收集了在心脏监护病房（CCU）因CTD-PAH需要左西孟旦治疗的急性失代偿性RHF患者的生物学、临床和人口统计学数据以及治疗数据。根据左西孟旦治疗情况将患者分为两组。对两组患者在住院期间和随访时的信息进行系统比较。
与对照组相比，左西孟旦组的混合静脉血氧饱和度（SvO）、估算肾小球滤过率（eGFR）、24小时尿量和三尖瓣环平面收缩期位移（TAPSE）显著升高。与对照组相比，左西孟旦组患者的C反应蛋白（CRP）、白细胞（WBC）、肌钙蛋白I、肌酐、N末端脑钠肽前体（NT-proBNP）水平和右心室直径显著降低。左西孟旦组的生存率更高。
左西孟旦治疗可有效改善CTD-PAH患者的急性失代偿性RHF和体循环血流动力学，对住院生存率有积极影响，因此可被视为改善临床短期结局的一种替代治疗选择。
