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首页> 外文期刊>Cardiovascular therapeutics >Levosimendan Improves Hemodynamic Status in Critically III Patients with Severe Aortic Stenosis and Left Ventricular Dysfunction: An Interventional Study
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Levosimendan Improves Hemodynamic Status in Critically III Patients with Severe Aortic Stenosis and Left Ventricular Dysfunction: An Interventional Study

机译：左西孟旦改善严重重度主动脉瓣狭窄和左心室功能不全的严重III级患者的血流动力学状态：一项干预研究

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Aims: To study the hemodynamic effect of levosimendan administration in acute heart failure patients with severe aortic stenosis (AS) and reduced left ventricular ejection fraction (LVEF). Methods: Hemodynamic response to 24 h intravenous levosimendan infusion (0.1 mu g/kg/min without a loading dose) in patients with severe AS (aortic valve area <= 1 cm(2), time-velocity integral between left ventricular out-flow tract and aortic valve <0.25), reduced LVEF (<= 40%), and a depressed cardiac index (CI) <2.2 L/min/m(2) was determined in a sequential group of nine patients aged 76 +/- 10 years (5 men). Results: Baseline mean ejection fraction was 33 +/- 0.7%; mean aortic valve area was 0.37 +/- 0.11 cm(2)/m(2); peak and mean gradients of 63.6 +/- 20.53 and 36.7 +/- 12.62 mmHg, respectively; and mean CI was 1.65 +/- 0.20 L/min/m(2). At 6 and 12 h of levosimendan therapy, mean CI had increased to 2.00 +/- 0.41 L/min/m(2) (P = 0.02) and 2.17 +/- 0.40 L/min/m(2) (P = 0.01), respectively. At 24 h, mean CI had increased further to 2.37 +/- 0.49 L/min/m2 (P = 0.01). A significant beneficial effect was also observed in pulmonary capillary wedge pressure, pulmonary artery mean pressure, central venous pressure, systemic vascular resistances, pulmonary vascular resistances, stroke volume index, left ventricular stroke work index. NTproBNP levels decreased at 24 h of levosimendan treatment. Levosimendan infusion was also well tolerated. Five patients subsequently underwent aortic valve surgery replacement. One died (of postoperative multiorgan failure). At 30 days, overall survival was 75%. Conclusions: Levosimendan administration improves hemodynamic parameters in critically ill patients with severe AS and reduced LVEF. In our study, it provides a safe and effective bridge to aortic-valve replacement or oral vasodilator therapy in surgical contraindicated patients. A controlled study is needed to confirm these preliminary findings.
机译：目的：研究左西孟旦对急性心力衰竭合并严重主动脉瓣狭窄（AS）和左心室射血分数（LVEF）降低的患者的血流动力学影响。方法：严重AS患者（主动脉瓣面积<= 1 cm（2），左心室流出道之间的时间速度积分）对24 h左西孟旦静脉滴注（0.1 mg / kg / min，无负荷剂量）的血流动力学反应在9例年龄为76 +/- 10的患者中，依次确定导管和主动脉瓣<0.25），LVEF降低（<= 40％）和心脏指数（CI）下降<2.2 L / min / m（2）。年（5名男性）。结果：基线平均射血分数为33 +/- 0.7％;平均主动脉瓣面积为0.37 +/- 0.11 cm（2）/ m（2）;峰值和平均梯度分别为63.6 +/- 20.53和36.7 +/- 12.62 mmHg;平均CI为1.65 +/- 0.20 L / min / m（2）。在左西孟旦治疗6和12小时时，平均CI增加到2.00 +/- 0.41 L / min / m（2）（P = 0.02）和2.17 +/- 0.40 L / min / m（2）（P = 0.01 ）， 分别。在24小时时，平均CI进一步提高到2.37 +/- 0.49 L / min / m2（P = 0.01）。在肺毛细血管楔压，肺动脉平均压力，中心静脉压，全身血管阻力，肺血管阻力，卒中体积指数，左心室卒中工作指数方面也观察到显着的有益作用。左西孟旦治疗24 h NTproBNP水平下降。左西孟旦注射液也被很好地耐受。随后有五名患者接受了主动脉瓣置换手术。 1人死于（术后多器官功能衰竭）。在30天时，总生存率为75％。结论：左西孟旦给药可改善重症AS并降低LVEF的危重患者的血液动力学参数。在我们的研究中，它为手术禁忌症患者的主动脉瓣置换或口服血管扩张剂治疗提供了安全有效的桥梁。需要进行对照研究以确认这些初步发现。

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