Zhang Han, Jiang Li, Fu Rui, Qin Ping, Zhang Xuan, Tian Tao, Feng Guang-Xun, Yang Yan-Min
Emergency Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Cardiovasc Med. 2022 Oct 19;9:986039. doi: 10.3389/fcvm.2022.986039. eCollection 2022.
Acute heart failure (AHF) is associated with high mortality. Levosimendan, an inodilator, has proved to increase cardiac output and exert renoprotective effect in AHF. Our aim was to investigate the efficacy and renoprotective effects of levosimendan in patients with AHF and different renal function.
This is a prospective, observational, multi-center registry. Patients admitted with AHF between June 2020 and May 2022 and treated with levosimendan during the hospital stay were included. Baseline characteristics, laboratory tests, electrocardiogram (ECG), chest X-ray, echocardiography, and treatment were collected. A 5-point Likert scale was used to document patients' baseline dyspnea. The estimated glomerular filtration rate (eGFR) was calculated by means of the Modification of Diet in Renal Disease equation. After levosimendan infusion, patients underwent assessment of degree of dyspnea, and levels of brain-type natriuretic peptide (BNP) /N-terminal pro-BNP (NT-pro BNP), and eGFR repeatedly.
Among 789 AHF patients who received levosimendan treatment in this study, 33.0 % were female, mean age was 64.9 ± 16.8 years, and mean eGFR was 72.6 ± 32.5 ml/min/m. The mean score of dyspnea was 3.0 ± 1.0 using 5-point Likert scale before levosimendan infusion. Dyspnea improved in 68.7% patients at 6h after infusion of levosimendan, and in 79.5% at 24 h. Lower eGFR was associated with lower efficacy rate after 6h infusion (71.7, 70.7, 65.2, and 66.0%, respectively) and after 24 h infusion (80.5, 81.4, 76.2, and 77.8%, respectively). The levels of BNP or NT-pro BNP were also decreased after levosimendan treatment, and in each eGFR category. Levels of eGFR increased from baseline (72.6 ± 32.5 ml/min/m) to 12-24h (73.8 ± 33.5 ml/min/m) and 24-72h (75.0 ± 33.4 ml/min/m) after starting treatment ( < 0.001). However, the eGFR levels increased only in patients with eGFR lower than 90.0 ml/min/m.
In AHF patients who received levosimendan, degree of dyspnea and levels of BNP or NT-pro BNP were significantly improved, especially in patients with higher eGFR levels. However, levosimendan infusion increase eGFR only in AHF patients with renal dysfunction.
急性心力衰竭（AHF）与高死亡率相关。左西孟旦作为一种血管扩张剂，已被证明可增加心输出量，并在AHF中发挥肾脏保护作用。我们的目的是研究左西孟旦在不同肾功能的AHF患者中的疗效和肾脏保护作用。
这是一项前瞻性、观察性、多中心注册研究。纳入2020年6月至2022年5月因AHF入院并在住院期间接受左西孟旦治疗的患者。收集基线特征、实验室检查、心电图（ECG）、胸部X线、超声心动图和治疗情况。采用5分制李克特量表记录患者的基线呼吸困难情况。通过肾病饮食改良方程计算估算肾小球滤过率（eGFR）。在输注左西孟旦后，反复评估患者的呼吸困难程度、脑钠肽（BNP）/N末端B型利钠肽原（NT-pro BNP）水平和eGFR。
在本研究中接受左西孟旦治疗的789例AHF患者中，33.0%为女性，平均年龄为64.9±16.8岁，平均eGFR为72.6±32.5 ml/min/m²。在输注左西孟旦前，使用5分制李克特量表测得的平均呼吸困难评分为3.0±1.0。输注左西孟旦6小时后，68.7%的患者呼吸困难得到改善，24小时后为79.5%。较低的eGFR与输注6小时后（分别为71.7%、70.7%、65.2%和66.0%）和24小时后（分别为80.5%、81.4%、76.2%和77.8%）较低的有效率相关。左西孟旦治疗后，BNP或NT-pro BNP水平也有所下降，且在每个eGFR类别中均如此。治疗开始后，eGFR水平从基线（72.6±32.5 ml/min/m²）升至12 - 24小时（73.8±33.5 ml/min/m²）和24 - 72小时（75.0±33.4 ml/min/m²）（P<0.001）。然而.eGFR水平仅在eGFR低于90.0 ml/min/m²的患者中升高。
在接受左西孟旦治疗的AHF患者中，呼吸困难程度以及BNP或NT-pro BNP水平显著改善，尤其是在eGFR水平较高的患者中。然而，左西孟旦输注仅在肾功能不全的AHF患者中增加eGFR。
