| Objective Heart failure is a common and growing problem associated with frequentadmissions to hospital and a poor prognosis.It is the one most frequent reason forhospital admissions in people aged over65years. It is the one most frequentreason for hospital admissions in people aged over65years. As a novel agent,levosimendan has been used for ten years. Levosimendan has a dual mechanism of actiondeveloped for the treatment of decompensated heart failure. Its effect is mediated bystereoselective sensitisation of calcium binding to cardiac troponin C, thus improving thehearts contractile function without increasing intracellular calcium concentration. It hasbecome the focus in the heart failure drugs in recent years. Although levosimendan aretheoretically attractive, to date a little has been about its Efficacy and safety as a clinicalagent. We conducted a randomized controlled trial of the short term intravenous infusionof levosimendan in72patients with severe heart failure due to evaluate the efficacy andsafety of levosimendan.Method we collected72patients with severe heart failure from december to April2013from the cardiology department of the people hospital of shanxi province.Randomly divided into two groups，36control group，36levosimendan group. Theyrandomly received the leosimendan and traditional heart failure therapy or onlytraditional heart failure therapy. All the patients were treated with electrocardiographmonitoring, Semi-Fowler’s rest, oxygen uptake. The levosimendan group addedlevosimendan if the routine anti-heart failure treatment (digoxin, ACEI/ARB,diuretics,vasodilator agent)did not work.We collected information as follows：1.Heart rate(HR),systolic blood pressure(SBP) and diastolic blood pressure(DBP) before and1,3days afteradministration;2. N-terminal Pro-Brain Natriuretic Peptide （NT-proBNP）， Left VentricularE jection Fraction（LVEF）, fraction shortening(FS)，left ventricular internaldiameter at end-diastole （LVEDD）， NYHA class, dyspnea， liver function,renalfunction,electrolyte, blood routine.Results1.General and clinical characteristics:72cases,63(87.5%) male,wereincluded in this study. The average age was80.4±7.1years，between73-88years. Therewere no significant differences in age, gender, among the three groups (P>0.05).2. After72hours treatment, dyspnoea improved in94.4%and75%patients with baselinesymptoms in the levosimendan and control groups, respectively. The improving ofdyspnoea of levosimendan group was better than control group (P<0.05). NYHAimproved in33(89%) of36and26(72%) of36patients in the levosimendan anddobutamine groups, respectively. NYHA of levosimendan group improved markedlythan control group (P<0.05).3. After72hours of treatment, LVEF and FS of both twogroups were increase than baseline (P<0.05), The improving of LVEF and FS oflevosimendan group was also better than control group (P<0.05). Comparing withbaseline, LVIDd of levosimendan group and control group was no significantdifferences(P>0.05).4. After72hours treatment, NT-proBNP levels of both two groupswere decrease(P<0.05), and NT-proBNP of levosimendan group reduced markedly thancontrol group(P<0.05).5. During the treatment, There were2cases frequent ventricularpremature beat in leosimendan group and3cases in control group,there were nosignificant differences between the two groups(P>0.05). There was no significantdifferences in blood pressure between baseline and72hours of treatment, comparingwith baseline,heart rate of treatment was decrease (P<0.05). While there are nosignificant differences in blood pressure and heart rate among two groups.The levels ofScr,BUN,ALT,AST,K+and HGB showed no significant differences before and afteradministration in both two groups.Conclusion1. Levosimendan can further improve cardiac function in patients withrefractory heart failure.2.Levosimendan can improve the haemodynamic performance ofpatients with refractory heart failure.3. Short-term treatment with levosimendan is safe and feasible in patients with refractory heart failure. |
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