Περίληψη:
Background: Levosimendan is a novel inodilator that improves central
haemodynamics and symptoms of patients with decompensated chronic heart
failure. The role, however, of repeated levosimendan infusions in the
management of these patients has not yet been properly assessed.
Purpose: This randomised placebo-controlled trial investigated the
effects of serial levosimendan infusions on cardiac geometry and
function, and on biomarkers of myocardial injury and neurohormonal and
immune activation (troponin T, N-terminal B-type natriuretic pro-peptide
(NT-proBNP), C reactive protein (CRP) and interleukin (IL) 6) in
patients with advanced heart failure.
Methods: 25 patients with decompensated chronic heart failure were
randomised (2: 1) to receive five serial 24-h infusions (every 3 weeks)
of either levosimendan (n = 17) or placebo (n = 8), and were evaluated
echocardiographically and biochemically before and after each drug
infusion and 30 days after the final infusion.
Results: Following treatment, cardiac end-systolic and end-diastolic
dimension and volume indices were significantly reduced only in the
levosimendan-treated patients (p < 0.01). A significant decrease in
NT-proBNP (p < 0.01), high-sensitivity CRP (p < 0.01) and plasma IL6 (p
= 0.05) was also observed in the levosimendan group, whereas these
markers remained unchanged in the placebo group; similar changes were
observed after each drug infusion. Although the number of patients with
a positive troponin T (>= 0.01 ng/ml) was not different between the two
groups at baseline, it was significantly higher in the placebo-treated
group during the final evaluation (p < 0.05).
Conclusion: Serial levosimendan treatments improved left ventricular
performance and modulated neurohormonal and immune activation
beneficially in patients with advanced heart failure, without increasing
myocardial injury.
Συγγραφείς:
Parissis, J. T.
Adamopoulos, S.
Farmakis, D.
Filippatos, G.
and Paraskevaidis, I.
Panou, F.
Iliodromitis, E. and
Kremastinos, D. Th
