Clinical Evaluation Of Levosimendan In Patients With Severe Systolic Heart Failure

Objective：Taking levosimendan based on conventional medicine therapy,to evaluatethe clinical efficacy,safety and prognosis of levosimendan in patients with severesystolic heart failure.Methods：The information of92enrolled patients with systolic heart failure wascollected from the Second Hospital of Jilin University from September2011toJanuary2014.The enrolled patients’ New York Heart Association (NYHA) Class wasⅢ-Ⅳ and the result of echocardiography showed left ventricular ejectionfraction(EF)≤40%.And they were divided into levosimendan group(n=32),milrinonegroup(n=30)and control group(n=30)according to randomized controlled method.Thecontrol group were treated with conventional medicine,include Angiotensin-converting enzyme inhibitors(ACEI) or Angiotensin Ⅱ receptor antagonist(ARB),β-blockers,Aldosterone receptor antagonist(MRA),diuretics,nitrates,digitalis;On thebasis of conventional medicine therapy,levosimendan was administered as an initialloading dose of12ug/kg delivered over10min followed by a continuous infusion of0.1ug/kg/min for an hour.If the patients were tolerant,that could be increased to0.15-0.2ug/kg/min for further23hours in levosimendan group.As same as in milrinonegroup,on the basis of conventional medicine therapy,milrinone was infused as an doseof0.375ug/kg/min for an hour.If the patients were tolerant,that could be increased to0.5-0.75ug/kg/min in the following23hours.The study monitored targets asfollows:vital signs,laboratory parameters and cardiac function targets beforeadministration and7days after administration.During the observation,the incidence ofmajor adverse cardiac events,the adverse reactions and the number of days in hospitalwere recorded and the readmission because of the aggression of heart failure wasfollowed up for3months.Results:1Taking levosimendan based on conventional medicine therapy,patients withsevere systolic heart failure felt a better cardiac function and less labored breathingobviously.After seven days of treatment,the effect of improved respiratory function onpatients in levosimendan group was1.661times of that in milrinone group and controlgroup.And the results were of statistical meaning(x2=5.180,P=0.039).At themeantime,the effect of improved cardiac function on patients in levosimendan groupwas1.787and1.970times of that in milrinone group and control group respectivelywith statistical meaning x2=5.199,P=0.041; x2=6.458,P=0.011).2Taking levosimendan based on conventional medicine therapy,the EF and SV ofpatients with severe systolic heart failure increased and BNP decreased evidently.After seven days of treatment,the difference of results were of statistical meaning bycomparing BNP only between levosimendan group and control group(t=-2.438,P=0.018); the difference of results were of statistical meaning by comparing EFbetween levosimendan group and milrinone group(t=4.149,P<0.001),levosimendan group and control group(t=5.022,P<0.001);the results of SV comparison were gainedstatistically only between levosimendan group and control group(t=3.257,P=0.002).3After the treatment, the length of stay of patients in levosimendan group,milrinonegroup and control group was11.9±5.28,14.1±7.1and14.8±4.78respectively,but theresults of which were gained statistically only between levosimendan group andcontrol group(t=-2.257,P=0.028).The data on readmission in3months was9(28.1%),11(36.7%)and13(43.3%)respectively.But the difference was of no anystatistical meaning.4Taking levosimendan and milrinone based on conventional medicine therapy,theliver function,kidney function,K,Na,HB and HCT of patients were not influencedsignificantly(P>0.05).5Taking levosimendan and milrinone based on conventional medicinetherapy,cardiovascular events and cardiovascular adverse reactions didn’t increase onthe whole(P>0.05).Conclusion:1Taking levosimendan based on conventional medicine therapy,patientswith severe systolic heart failure felt a better cardiac function and less laboredbreathing obviously.After seven days of treatment,the effect of improved respiratoryfunction on patients in levosimendan group was1.661times of that in milrinone groupand control group.At the meantime, the effect of improved cardiac function on patientsin levosimendan group was1.787and1.970times of that in milrinone group andcontrol group respectively.2Taking levosimendan based on conventional medicine therapy,the EF and SV ofpatients with severe systolic heart failure rose and BNP decreased evidently.3Taking levosimendan based on conventional medicine therapy,the length of staywas reduced,and could have the trend to reduce the readmission in3months.4Taking levosimendan based on conventional medicine therapy is feasible and safe.