Effect of levosimendan on cardiac function, hemodynamics and inflammatory factors in patients with acute heart failure

Zhou Hongyu; Li Xuguang; Yan Biqing

doi:10.3760/j.issn.1673-4777.2018.11.002

Abstract：Objective To analyze the effect of levosimendan on cardiac function,hemodynamics and inflammatory factors in patients with acute heart failure.Methods A total of 96 acute heart failure patients admitted from January 2015 to October 2017 in the Affiliated Hospital of Medical School of Ningbo University were randomly divided into levosimendan group and control group,with 48 cases in each group.The control group was treated with milrinone injection.The levosimendan group was treated with levosimendan injection.Cardiac function indexes [B-type natriuretic peptide (BNP),left ventricular ejection fraction (LVEF),left ventricular end-diastolic diameter(LVDD)],hemodynamic parameters [pulmonary capillary wedge pressure (PCWP),pulmonary arterial mean pressure (PAMP),cardiac index (CI),systemic vascular resistance (SVR),right atrial pressure (RAP)] and inflammatory factors [high-sensitivity C-reactive protein (hs-CRP),interleukin-6 (IL-6),tumour necrosis factor-α(TNF-α)] were detected before and after treatment.Therapeutic effect was assessed after treatment.Results There were no significant differences of BNP,LVEF,LVDD,PCWP,PAMP,CI,SVR,RAP,hs-CRP,IL-6 and TNF-α between groups before treatment(all P ＞ 0.05).After treatment,the indicators showed significant improvements compared to the baselines;BNP and LVDD in levosimendan group were significantly lower than those in control group[(1 133 ±410)ng/L vs (1 781 ±497) ng/L,(55 ± 10)mm vs (58 ± 10)mm];LVEF in levosimendan group was significantly higher than that in control group [(46 ± 8) ％ vs (40 ± 7) ％];PCWP,PAMP,SVR and RAP in levosimendan group were significantly lower than those in control group[(58 ± 10)mmHg vs (18 ±9)mmHg,(23±9)mmHg vs (27 ±9)mmHg,(1 196 ±467)dyn/(·s· cm) vs (1 507 ± 497)dyn/(s · cm),(6.3 ±4.1) mmHg vs (6.8 ± 3.9) mmHg];CI in levosimendan group was significantly higher than that in control group [(2.9 ± 0.7) L/(min · m2) vs (2.6 ± 0.7) L/(min · m2)];levels of hs-CRP,IL-6 and TNF-α in levosimendan group were significantly lower than those in control group[(1.2 ± 0.7) mg/L vs (2.0±0.9)mg/L,(7.1 ± 1.4)ng/L vs (9.2 ± 1.6) ng/L,(0.88 ±0.21) ng/L vs (1.23 ±0.29)ng/L] (all P ＜ 0.05).The total effective rate in levosimendan group was significantly higher than that in control group [87.5 ％ (42/48) vs 75.0％ (36/48)] (P =O.006).Conclusion Levosimendan can improve cardiac function,hemodynamic state and reduce inflammation more significantly than milrinone in treatment of acute heart failure.