左西孟旦对正常血压患者心力衰竭的影响:负荷剂量是否重要?

Acute cardiac care Pub Date : 2015-03-01 Epub Date: 2015-03-25 DOI:10.3109/17482941.2015.1005102
Elisabetta Palmerini, Stefan Söderberg, Sergio Mondillo, Roberto Favilli, Stefano Lunghetti
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引用次数: 1

摘要

背景:左西孟旦是一种钙敏化剂和K(+)-ATP通道开放剂,与心肌耗氧量无关,具有肌力和血管扩张作用,用于治疗心力衰竭(HF)。负荷剂量通常通过输注给药12小时;然而,大幅度降低血压往往会中断或延长输注时间。本研究的目的是评估不同左西孟旦治疗方案(有或没有负荷剂量)的临床、生化和心肌差异,并与心力衰竭的标准治疗进行比较。方法:纳入57例HF、纽约心脏协会(NYHA) III-IV级、左室射血分数(LVEF)降低患者(平均年龄±SD: 60.9±9.3岁,男性45例)。20例患者(NB组)给予左西孟丹无负荷治疗,14例患者(B组)给予左西孟丹有负荷治疗,23例患者(C组)给予标准治疗。临床、生化和超声心动图特征在基线和治疗后一周进行评估。结果:各组在基线时相似。1周后NHYA评分(P < 0.001)、NT pro-BNP评分(P < 0.001)、LVEF评分(P = 0.045)、E/A评分(P = 0.048)、E/ E '评分(P < 0.001)、PAPs评分(P < 0.001)下降。各组DT (P = 0.011)、TAPSE (P = 0.035)均升高。结论:无论负荷剂量如何,左西孟旦和标准治疗都能改善心衰的心肌功能和症状。对传统药物治疗难治性终末期心力衰竭患者的治疗选择是有限的。肌力药物在心力衰竭(HF)中起重要作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Effects of levosimendan on heart failure in normotensive patients: does loading dose matter?

Background: Levosimendan is a calcium sensitizer and K(+)-ATP channel opener with inotropic and vasodilatatory effects irrespective of myocardial oxygen consumption, used for treatment of heart failure (HF). A loading dose is usually given by infusion for 12 h; however, profound lowering of blood pressure often disrupts or prolongs the infusion. The aim of this study was to assess clinical, biochemical and myocardial differences between different regimes of levosimendan therapy, with or without loading dose, and compared to standard therapy in heart failure.

Methods: Fifty-seven patients (mean age ± SD: 60.9 ± 9.3 years, 45 males) with HF, New York Heart Association (NYHA) III-IV, reduced left ventricular ejection fraction (LVEF) were included. Twenty patients (NB group) were given levosimendan without loading dose, 14 patients (B group) were given levosimendan with loading dose, and 23 patients (C group) were given standard therapy. Clinical, biochemical and echocardiographic characteristics at baseline and one week after treatment were evaluated.

Results: Groups were similar at baseline. After one week NHYA class (P < 0.001), NT pro-BNP (P < 0.001), LVEF (P = 0.045), E/A (P = 0.048) E/e' (P < 0.001), and PAPs (P < 0.001) decreased. DT (P = 0.011) and TAPSE (P = 0.035) increased in all groups.

Conclusions: Levosimendan, as well as standard therapy, improves myocardial function and symptoms of HF, irrespective of the loading dose administration. Treatment options for patients with end-stage heart failure refractory to conventional medical therapy are limited. Inotropic drugs play an important role in heart failure (HF).

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