The Clinical Efficacy And Safety Of Levosimendan In Patients With Acute Heart Failure

Heart failure (HF) is a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood. Heart failure, which is the end stage of cardiovascular disease, has become a worldwide focus because of the high incidence.Levosimendan is a new type of calcium sensitizer, which could enhance myocardial contraction by binding to TnC on the myocardial cell. What’s more, Levosimendan could dilate vessels and slightly inhibit the effects of phosphodiesterase, by interacting with the ATP-mediated K+ channels. Also, Levosimendan could improve clinical symptoms, without increasing oxygen consumption.NT-proBNP is the most important biomarker for clinical heart failure diagnosis. Meanwhile,2014 Chinese guideline indicates that NT-proBNP declined no less than 30% could be an important standard for evaluating therapeutic efficacy and prognosis. Therefore, our research uses a 30% drop in the NT-proBNP as the standard to evaluate the efficacy and safety of Levosimendan.Purpose This study aims to evaluate the efficacy and safety of Levosimendan on acute heart failure, on the basis of a 30% drop in the NT-proBNP.Methods We collected clinical information of 108 acute heart failure patients in the CCU, who were divided into two groups:Levosimendan group and control group. All participants stayed in bed and received conventional monitor and medicine treatment, such as diuretics, β-blockers and ACEI/ARB. Levosimendan was administered as a continuing microdosis venous pump of 0.1 μg/kg/min consisted over than 24 hours.Then, we analyze the changes after receiving treatment in both groups.Results1. Blood pressure lowered in both groups, but there was no significant difference between two groups(SBP:P=0.258; DBP:P=0.122);2. Compared to baseline,24 hours urine volume in Levosimendan group increased significantly, but not in control group;3. The NT-proBNP significantly decreased in both groups, and it’s more obviously in Levosimendan group (P=0.044). More patients achieved the goal of NT-proBNP in Levosimendan group (78.57%) than the control group (59.62%);4. Levosimendan could significantly improve dyspnea, which was superior to control group (the efficient was 76.79% in Levosimendan group and 57.69% in control group, P=0.034); and when NT-proBNP dropped over than 30%, the superiority was more obvious;5. The improvement of NYHA of Killip class of Levosimendan group was superior to that of control group (the efficient was 83.93% in Levosimendan group and 57.69% in control group, P=0.003); similarly, the superior was obvious on the basis of a 30% drop in the NT-proBNP.;6. LVEF improved in both groups, however, there was no significant difference between them (P=0.854);7. Levosimendan did not cause more adverse events compared to control group;8. There was no significantly difference of all-cause mortality between two groups (P=0.850); however, there was a tendency of decreasing in mortality, if the NT-proBNP dropped over 30%.Conclusion1. Levosimendan could significantly improve dyspnea, NYHA or Killip class and LVEF; Levosimendan could obviously decrease NT-proBNP no less than 30%;2. Levosimendan added to conventional treatment could not increase all-cause mortality and other adverse events;3. On the basis of a 30% drop in the NT-proBNP, the improvement of dyspnea, LVEF and NYHA (or Killip) class was significant; and all-cause mortality seemed to be reduced. So a 30% drop in the NT-proBNP could be a good standard to evaluate the treatment of acute failure.