| Objectives:To observe the difference of clinical efficacy of intermittent repeated infusions of levosimendan in patients with HFrEF due to ischemic and non-ischemic cardiomyopathy.Methods:Patients with HFrEF who were hospitalized at the Heart Failure Center of Sichuan Provincial People’s Hospital from Jan,2018 to Dec,2022 were retrospectively screened,and divided into ischemic and non-ischemic cardiomyopathy groups,then 133 patients who completed 6 times intermittent repeat levosimendan treatments were enrolled.After propensity score matching(PSM,ICM:NICM=1:3),28patients in the ICM group and 56 patients in the NICM group were obtained.Observation indicators:efficacy indicators:the changes of cardiac function parameters before and after levosimendan treatment,including B-type natriuretic peptide(BNP),left ventricular ejection fraction(LVEF),left ventricular end-diastolic internal diameter(LVEDD);other indexes:estimated glomerular filtration rate(eGFR),serum creatinine(Scr),creatine kinase-MB(CK-MB),high-sensitivity troponin I(Hs-cTnI),and hypotensive events.Baseline data and above observation indicators before and after levosimendan treatment were collected to observe the clinical efficacy before and after treatment and to compare the difference in efficacy between the two groups.Results:After PSM,there were no significant difference between the two groups in age,sex,systolic blood pressure,heart rate,complications(diabetes and hypertension),BNP,LVEF,eGFR,Scr,CK-MB,Hs-cTnI,and the drugs applications for anti-heart failure(P>0.05).The proportion of renal dysfunction was higher in the ICM group(57.1%vs.32.1%,P=0.03),LVEDD was larger in the NICM group(60.3±9.1mm vs.65.2±8.1mm,P=0.03),and the application digoxin was higher(64.3%vs.89.3%,P<0.01).After 6 cycles of levosimendan treatment,the level of BNP in ICM and NICM group decreased significantly,the LVEF level increased significantly,and LVEDD in NICM group decreased significantly,all changes were statistically significant;NICM group showed greater changes in LVEF and LVEDD[ΔLVEF(34.1±47.1%vs.63.9±76.1%)、ΔLVEDD(-2.8±11.7%vs.-10.8±11.8%),P<0.05,Δ=(after-before)/before];There was no significant difference in the changes of BNP between the two groups(ICM:NICM,-55.7±45.3%vs.-65.1±35.0%).The levels of Scr(107.4±50.7μmol/L vs.121.3±54.5μmol/L,P<0.05)and eGFR(64.6±21.6ml/min/1.73m~2vs.58.3±20.0ml/min/1.73m~2,P<0.05)decreased in ICM group,but the variations[ΔScr(ICM:18.4±28.7%vs.NICM:9.8±30.8%),ΔeGFR(ICM:-7.5±23.0%vs.NICM:-4.2±25.7%)]were not statistically significant between the two groups(P>0.05).The level of CK-MB in NICM group and the Hs-cTnI of two groups were decreased(P<0.05),and there was no significant change about CK-MB in ICM group.The incidence of hypotension was similar in both groups during treatment(ICM:NICM,46.4%vs.44.6%,P>0.05).Conclusion:Compared with the NICM group,there was no efficacy difference in BNP,eGFR,SCr and Hs-cTnI with intermittent repeated infusions of levosimendan for ICM.The level of BNP decreased and LVEF increased significantly in both groups after treatment,and the increase of LVEF and effect of reverse remodelling of the left ventricle were more significant in NICM group.The incidence of hypotension was similar in both groups. |
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