J. Cornejo-Avendaño , J. Azpiri-López , A. Ramírez-Rosales
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引用次数: 1
摘要
目的评价左西孟旦与多巴酚丁胺或安慰剂相比治疗急性失代偿性心力衰竭的风险和获益。方法:检索Cochrane中央对照试验登记册(Central)、欧洲心脏杂志和美国心脏病与循环学院杂志，寻找在年龄≥18岁、诊断为急性失代偿性心力衰竭(NYHA III级和IV级心力衰竭，左室射血分数为0.35)的任何病因的患者中，左西咪旦静脉输注24 h与多巴酚丁胺或安慰剂相比的随机临床试验。肺动脉导管楔压15mmhg或心脏指数2.5 ml/min/m2。结果27例临床试验(2747例)符合本综述的纳入标准。左西孟旦与NYHA分级OR显著增加相关(95% CI 1.23-7.59;p = 0.02)，改善疲劳倾向OR为1.80 1.53 (IC95% 0.99-2.39, p = 0.06)，临床改善综合OR为1.20 (IC95% 0.99-1.46;P = 0.06)，与多巴酚丁胺或安慰剂相比。结论与多巴酚丁胺或安慰剂相比，左旋西孟旦治疗急性失代偿性心力衰竭可改善NYHA功能分级、LVEF和BNP水平，但副作用增加。
Levosimendan in acute decompensated heart failure: Systematic review and meta-analysis
Objectives
To assess the risks and benefits of levosimendan in acute decompensated heart failure compared to dobutamine or placebo.
Methods
Pubmed, the Cochrane Central Register of Controlled Trials (CENTRAL), the European Heart Journal, and the Journal of the American College of Cardiology and Circulation were searched for randomized clinical trials of a 24 h IV infusion of levosimendan compared to dobutamine or a placebo in patients ≥18 years old admitted with a diagnosis of acute decompensated heart failure of any etiology with a NYHA class III and IV heart failure, a left ventricular ejection fraction <0.35, pulmonary catheter wedge pressure >15 mmHg or cardiac index <2.5 ml/min/m2.
Results
Eleven clinical trials (2747 patients) met the inclusion criteria for this review. Levosimendan was associated with a significant increase in NYHA class OR 3.06 (95% CI 1.23–7.59; p = 0.02), and a tendency to improve fatigue OR 1.80 1.53 (IC95% 0.99–2.39, p = 0.06) and clinical improvement composite OR 1.20 (IC95% 0.99–1.46; p = 0.06), as compared to dobutamine or a placebo.
Conclusions
Levosimendan in acute decompensated heart failure improves NYHA functional class, LVEF and BNP levels when compared to dobutamine or a placebo, with an increase in side effects.
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