| Background:Acute coronary syndrome is regarded as a major precipitating factor for heart failure.Once patients with acute coronary syndrome progress to heart failure or cardiogenic shock,their prognosis will rapidly become worse.Despite the development of medical technology,the prognosis of patients with heart failure or cardiogenic shock complicating acute coronary syndrome is still poor.As a cardiotonic agent,levosimendan has been widely used in heart failure patients.However,the effects of levosimendan on patients with heart failure complicating acute coronary syndrome is still unclear up till now.Aims:This study was aimed to review relevant literature and evaluate whether levosimendan was associated with better clinical outcomes in patients with heart failure or cardiogenic shock complicating acute coronary syndrome.Data Sources:The PubMed,EMBASE and the Cochrane library were searched to identify randomized controlled trials that compared levosimendan to any control in patients with heart failure or cardiogenic shock complicating acute coronary syndrome,the deadline of which was August 18,2016.Eligible studies were extracted according to the inclusion and exclusion criteria.Data Extraction:Two reviewers independently evaluated the methodological quality and risk bias of enrolled studies,and extracted the data of interest.The data included first author,year of publication,study population,sample size(the number of patients in the levosimendan and control groups),levosimendan infusion(loading dose,maintain dose,duration of administration),control agent,time of follow up,mortality at the end of follow up,worsening heart failure,hemodynamic parameters and adverse events.All the detailed information was checked by a third reviewer.Results:A total of 1065 patients from 9 trials were subjected to this study.Analysis showed that levosimendan significantly reduced the total mortality and the incidence of worsening heart failure.In patients with heart failure complicating acute coronary syndrome,levosimendan was associated with reduced mortality;whereas in patients with cardiogenic shock complicating acute coronary syndrome,no significant difference was discovered between the two groups.Levosimendan contributed to significantly reduced mortality when compared with placebo;whereas no significant reduction was seen when it was compared with dobutamine.Compared with controls,levosimendan decreased pulmonary capillary wedge pressure,systemic vascular resistance,and increased cardiac index,with no significant difference observed between two groups in terms of heart rate.Levosimendan non-significantly increased the risk of hypotension and didn't increase the risks of ischemic episodes,sinus tachycardia,atrial fibrillation,and ventricular arrhythmias.Conclusion:Levosimendan might be a promising drug to reduce mortality and worsening heart failure in patients with heart failure or cardiogenic shock complicating acute coronary syndrome.It seemed to bring hemodynamic benefits and was associated with an increased risk of hypotension.Background:Aneurysm of the muscular interventricular septum is an abnormal out-punching of a portion of the interventricular septum which represents a thin and weakened area in the wall and which is usually dyskinetic or has paradoxical motion.The aneurysms might be congenital or acquired.The acquired reasons include transient coronary occlusion in fetal life,anomalous origin of the coronary artery,chest trauma,infection,cardiac surgery,Kawasaki's disease and myocardial infarction.If the etiology couldn't be ascertained,the aneurysm might be said to be congenital.Congenital aneurysm of the muscular interventricular septum is extremely rare,especially that without ventricular septal defect.As a result,the etiology,clinical course,treatment and prognosis of this disease remain uncertain nowadays.Aims:This study was aimed to summarize the possible pathogenesis,clinical course,diagnostic methods and treatment methods of congenital aneurysm of the interventricular septum,and provide useful information for clinicians.Methods:We collected the information of a patient with congenital aneurysm of muscular interventricular septum and searched relevant case reports in the PubMed database and CNKI database.By reviewing these reports,we summarized the etiology,clinical manifestation,complications,electrocardiogram changes,echocardiographic features and treatment methods of this disease.Results:We report a case of congenital aneurysm of muscular interventricular septum combined with congenital aneurysm of interatrial septum.He was diagnosed by echocardiography at the age of five and has been followed up in our institution for 11 years with no symptoms and no obvious progression of the aneurysms.By reviewing the former cases,we summarized the features of this disease as follows.First,congenital aneurysm of the muscular interventricular septum might follow the pattern of polygenic or autosomal dominant inheritance and might be associated with multiple factors including abnormal subendocardial vessels,non-synchronous growth or abnormal fusion of the mesenchymal cells,abnormal apoptosis of myocardial cells,fibrous or adipose infiltration and inflammatory cell infiltration.Second,interventricular septal aneurysm is largely a benign disease,despite that it might bring about several complications.It can exist alone or with other abnormalities.Third,most patients have nonspecific electrocardiogram changes.Forth,echocardiography is an indispensable tool for the diagnosis and follow up of this disease.Fifth,asymptomatic patients need no treatment,while patients with complications or severe co-existing abnormalities might need symptomatic treatment or surgical treatment.Finally,regular follow up is necessary for these patients.Conclusion:Congenital aneurysm of muscular interventricular septum is a rare disease with unknown etiology and largely benign clinical course.Clinicians should pay more attention to this disease due to its possible co-existing abnormalities and possible life-threatening complications. |
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