Levosimendan is a calcium sensitizer as a new type of positive strength-vasodilator. There are currently no research reports on the effectiveness and safety of early application of levosimendan in patients with severe ejection fraction .
Fuwai Hospital Zhang Jian, Zou Changhong and others found that the use of levosimengdan within 24 hours after admission to the hospital can significantly reduce plasma NT-proBNP levels, shorten the hospital stay time, and have no obvious adverse reactions.
study included 700 severe acute heart failure patients hospitalized in the heart failure ward of Fuwai Hospital from 2013 to 2020. When the patients were admitted to the hospital, the NYHA cardiac function classification Ⅱ~Ⅳ, left ventricular ejaculation fraction ≤35%, and plasma NT-proBNP>1000 pg/ml.
The patients who were admitted to the hospital with levosimendan within 24 hours were listed as the observation group (n=242), and the patients who did not use inotropic drugs during the hospitalization were used as the control group (n=458). Compared with
before treatment, plasma NT-proBNP in the observation group and control group decreased significantly after treatment (4~7 days in hospitalization).
And compared with the control group, the plasma NT-proBNP level was significantly lower after treatment in the observation group, and the proportion of plasma NT-proBNP level was ≥30% lower than before treatment (62.2% vs. 81.0%). The hospital stay in the
observation group was significantly shorter than that in the control group.
Although the in-hospital mortality rate was low, there was no difference between the two groups (2.9% vs. 3.5%). There was no difference in plasma NT-proBNP and ejection fraction index at 3 months and 6 months after discharge from the two groups of patients.
observation group patients decreased systolic blood pressure during the use of levosimendan (within 24 hours), and their heart rate increased, but after the treatment was completed, the levels of systolic blood pressure and heart rate remained stable within 5 days. The incidence of hypotension and is 1.2% to 4.1%, and the incidence of tachycardia is 3.3% to 4.5%, both lower than 5%. The incidence of VT in the observation group of patients within 7 days of hospitalization was 1.7% to 2.5%, both lower than 3%.
Moreover, there was no significant change in the hemoglobin, alanine aminotransferase, blood potassium and blood sodium levels before and after levosimendan treatment.
It should be noted that this study found that the effectiveness of the early single-use levosimendan application after admission seemed to disappear at 3 months or 6 months after discharge, suggesting that the duration of its efficacy should be considered when clinical application of levosimendan.
This study is the first time in the real world that further demonstrates the effectiveness and safety of levosimendan early after admission to patients with severe acute heart failure.
Source: Zou Changhong, Huang Yan, Zhou Qiong, et al. Analysis of the effectiveness and safety of leucimengdan early in the admission to the hospital with severe acute ejaculation fraction: Chinese Circulation Magazine , 2022, 37: 1105-1110. DOI: 10.3969/j.issn.1000-3614.2022.11.005. [Click on the QR code to view the original text]
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