| Background : In the past three decades,although we have made great progress in the knowledge and treatment of heart failure,the morbidity and mortality of patients with heart failure are still very high,resulting in a heavy social and economic burden.Levosimendan is widely used in patients with heart failure with reduced ejection fraction,but its effect on patients with heart failure with mildly reduced ejection fraction is not clear.Aims: to explore the short-term and long-term effects of levosimendan on patients with HFmrEF,and to provide theoretical basis for clinical use of positive inotropic drugs in patients with HFmrEF.Methods: 171 patients with HFmrEF were enrolled in the Department of Cardiology Cardiovascular intensive care unit,Xiangya second Hospital of Central South University from January 2019 to July2011.They were divided into two groups according to whether they used levosimendan during hospitalization.Levosimendan group(101 cases)and routine treatment group(70 cases).The data of patients were collected and followed up.The differences of prognosis and biomarkers between the two groups and the differences of biomarkers before and after treatment in levosimendan group were compared.Results: In this study,we included 171 patients with HFmrEF,including 101 patients in the levosimendan group and 70 patients in the conventional treatment group;the urine volume in the group increased significantly before and after treatment(1448.3 ± 890.4ml VS 2236.6 ±1024.4ml P<0.001),the hs-TnT decreased significantly before and after treatment(1265.8 ± 2251.2 pg/mL VS 706.5 ± 1263.7 pg/mL P=0.041),the NTpro-BNP decreased significantly on the 1st day and the NTpro-BNP on the 7th day after treatment(11998.1 ± 11550.5pg/mL VS8758.1 ± 10491.7pg/mL P=0.046,11998.1 ± 11550.5 pg/mLVS 6282.8± 8471.8pg/mL P<0.001),and the urea nitrogen decreased significantly before and after treatment(13.1 ± 9.1mmol/L VS 10.5 ± 6.8mmol/L P=0.026).Through the tendency matching analysis,the short-term benefit of the two groups after adjusting anti-heart failure drugs was compared.Compared with the routine treatment group,the 24-hour urine volume of levosimendan group increased more significantly(788.3 ±290.3ml VS224.4 ±114.4ml paired 0.024),and the level of NTpro-BNP decreased more significantly(3240.0 ±8110.2pg/mL VS 2998.7 ±7048.1pg/mL paired 0.039).The level of urea nitrogen decreased more significantly(2.6 ±6.7mmol/L VS 1.5 ±5.8mmol/L paired 0.046).In addition,the level of hs-TnT and NTpro-BNP7 d decreased,but there was no significant difference between the two groups.In this study,Kaplan Meier curves were used to compare the survival of patients with HFmrEF at the twelfth month between the conventional therapy group and the levosimendan group,and there was no significant difference in all-cause death between the two groups(p=0.69),and there was no significant difference in the composite endpoint of all-cause death and heart failure rehospitalization between the two groups(p=0.39)Conclusions: Levosimendan can improve the renal function of patients with heart failure with mildly reduced ejection fraction,increase urine volume,and decrease heart failure marker NT-proBNP more quickly,but levosimendan can not improve all-cause death and rehospitalization of patients with heart failure with with mildly reduced ejection fraction. |
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