| Objective:There are many causes of heart failure(HF),including myocardial ischemia after coronary artery stenosis and occlusion,viral myocarditis and myocardial damage caused by various cardiomyopathies,pressure overload caused by hypertension,aortic valve stenosis,etc.,as well as volume overload caused by valvular insufficiency and chronic anemia,in the early stage of the disease,the heart can be compensated by ventricular remodeling,when the condition continues to progress,the function of the heart will enter the decompensated stage,the pumping ability of the heart is seriously impaired,while there will not be enough blood can be delivered to the periphery,and stasis in the venous system,finally a series of symptoms such as dyspnea,fluid retention,and limitation of motion occur.Inotropic drugs are a commonly used class of drugs for the treatment of HF in clinical practice,which can increase myocardial contractility and improve symptoms and hemodynamics in a short time.Levosimendan(Levo)is a calcium sensitizer,which does not cause an increase in intracellular calcium concentration on the basis of increasing myocardial contractility,has little effect on myocardial oxygen consumption,it can also cause vasodilatation and improve blood perfusion.It is widely used in clinical practice.The aim of our study was to assess the effect of Levo on mortality in HF patients in a randomized controlled trial.Methods:A computerized literature search was performed in English databases including Pubmed,Embase,Web of science,and Cochrane library,and in Chinese databases including CNKI and Wanfang,The search included randomized controlled trials of levosimendan in HF,The retrieved data were summarized and analyzed to evaluate the effect of Levo on the death of HF patients and the safety compared with dobutamine.Results:After primary screening and full-text screening,the final number of included literatures was 16,involving a total of 2641 patients.Meta-analysis showed that the mortality rate was reduced after injection of Levo in patients with chronic heart failure[RR:0.50;95%CI(0.28-0.91);P=0.02],and the effect of Levo on the final mortality rate was reduced in patients with acute decompensated heart failure[RR:0.63;95%CI(0.42-0.97);P=0.03].Levosimendan had no significant survival advantage in mortality rate compared with dobutamine [RR:0.90;95%CI(0.76-1.05);P=0.17].Conclusion:Levosimendan can reduce mortality in patients with chronic heart failure and acute decompensated heart failure,but there is no significant advantage in the treatment of acute decompensated heart failure compared with dobutamine. |
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