| Objective:To study the effect of levosimendan in the cardiac function and exercise tolerance in patients with acute decompensated heart failure（ADHF）.Methods:From January 2020 to October 2020,the patients with acute decompensated heart failure who admitted to the Fifth Department of cardiology of the second hospital of Hebei Medical University were selected and randomly divided into levosimendan group and control group.The patients in the control group were received conventional anti-HF therapies.The patients in levosimendan group were given levosimendan besides of conventional treatment.According to blood pressure,levosimendan was slowly injected intravenously within 6-12μg/kg for 10 minutes,followed by intravenous infusion of 0.1～0.2μg/（kg·min）.The dosage of levosimendan can be adjusted to 0.2 ug/（kg·min）for 24 hours,if the patients have no adverse reactions.The treatment was repeated 7 days later.The cardiac function,exercise tolerance,N-terminal B-type natriuretic peptide（NT-pro BNP）,adverse events and major adverse cardiovascular events within 3 months were recorded.Results:A total of 78 patients with acute decompensated heart failure were divided into levosimendan group（n=38）and control group（n=40）.There was no significant difference in clinical baseline data between the two groups before treatment.The basic clinical data included gender,age,body mass index（BMI）,cause of heart failure,the levels of cholesterol（TC）,low density lipoprotein cholesterol（LDL-C）,Creatinine（Cr）and troponin I（TNI）,systolic blood pressure（SBP）on admission,diastolic blood pressure on admission,heart rate（HR）on admission,prevalence of hypertension,prevalence of diabetes,utilization rate of ACEI/ARB/ARNI,beta-blockers,spironolactone,diuretics,digoxin,and NYHA classification.There were no significant differences in heart rate,systolic blood pressure,diastolic blood pressure and creatinine between the two groups after treatments.There were no significant differences the cardiac function indexes before treatment（P>0.05）.The cardiac function indexes included left ventricular ejection fraction（LVEF）,left ventricular end diastolic diameter（LVEDD）,stroke volume（SV）,and the ratio of maximum velocity of mitral flow（E）and peak velocity of mitral annular motion（e,）in early diastolic phase of left ventricle.There was no significant difference in the level of NT-pro BNP between levosimendan group and control group before treatment（P>0.05）.After treatment,the efficiency of levosimendan group was 92.11%which was significantly higher than 75.00%of the control group（P<0.05）.LVEDD and E/e’of the two groups were significantly lower than those before treatment,while LVEF and SV were significantly higher than those before treatment（P<0.01）.Compared with the control group,the cardiac function indexes of levosimendan group improved more significantly（LVEF:40.34±5.85%vs 37.30±6.22%,LVEDD:52.48±6.00mm vs 56.10±9.45mm,SV:69.35（60.25,80.75）vs 59.00（54.08,72.58）ml,E/e’:16.68±8.63 vs 21.07±9.47,all P<0.05）.The level of NT-pro BNP in the two groups was significantly lower than that before treatment,and the level in the levosimendan group was significantly lower than the control group（1711.7±480.0 pg/ml vs 2235.9±714.4 pg/ml,P<0.05）.The indexes of exercise tolerance included peak oxygen uptake（VO2max）,anaerobic threshold（AT）and 6-minute walk testing（6MWT）.After treatment,VO2max,AT and 6MWT in levosimendan group were significantly improved compared with the control group（VO2max:20.95±3.20 ml/（kg·min）vs 17.94±311ml/（kg·min）,AT:12.27±2.68kg/min vs 10.96±2.28kg/min,6MWVT:433.80±117.49cm vs 383.05±107.01cm,all P<0.05）.There was no significant difference in the incidence of adverse reactions between the two groups（13.16%vs 22.50%,P>0.05）.The major adverse cardiovascular events within3 months in the levosimendan group were similar to the control group（15.79%vs 22.50%,P>0.05）.Conclusions:Levosimendan could significantly improve the cardiac function and exercise tolerance of patients with ADHF.And the exercise tolerance can provide the treatment basis for patients with cardiac rehabilitation training. |
