Treatment of myocardial infarction complicated by asymptomatic left ventricular systolic dysfunction with levosimendan

Zhu Yanqi

doi:10.3969/j.issn.1674-4055.2018.01.15

Abstract：Objective To discuss the clinical efficacy and safety of levosimendan in treatment of acute myocardial infarction (AMI) complicated by asymptomatic left ventricular systolic dysfunction. Methods AMI patients (n=148) received conservative treatment were chosen from the Department of Cardiology of the First People's Hospital of Pingdingshan City from Feb. 2015 to Jan. 2017, and the randomly divided into control group and treatment group (each n=74). The control group was given bayaspirin (orally, 300 mg/d), pravastatin (orally, 20 mg/d) and clopidogrel (orally, 300 mg/d) for routine treatment of anti-platelet aggregation, anticoagulation, anti-ischemia and thrombolysis and additionally, given β-receptor blocker (orally, 50 mg-100 mg/time, twice a day). The treatment group was, besides of the same therapy as that of control group, given additionally intravenous injection of levosimendan in loading dose (12 μg/kg) at first for≥10 min, and then continuous intravenous pumping [0.05 μg-0.2 μg/(kg·min)] for 24 h. The changes of heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were observed before treatment and 7 d after treatment. The NYHA grades, and levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and insulin-like growth factor-1 (IGF-1), and left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV) and stroke volume (SV) were detected before treatment and 7 d after treatment. Results After treatment for 7 d, the difference in HR had statistical significance (P<0.05), but difference in SBP and DBP had no statistical significance (P>0.05). After treatment for 7 d, the difference in LVEF, SV, LVEDV and LVESV had statistical significance (P<0.05), and LVEF and SV were higher and LVEDV and LVESV were lower in treatment group than those in control group. After treatment for 7 d, the difference in NT-proBNP and IGF-1 had statistical significance (P<0.05). After treatment for 7 d, the difference in NYHA grades had statistical significance(P<0.05). The difference in occurrence of adverse reactions had no statistical significance (P>0.05). Conclusion Levosimendan is significantly effective in treatment of AMI complicated by asymptomatic left ventricular systolic dysfunction with lower incidence of adverse reactions, which is worth clinical promoting.