Comparison of the Effects of Levosimendan Dobutamine and Vasodilator Therapy on Ongoing Myocardial Injury in Acute Decompensated Heart Failure

Gencer, Erkan; Doğan, Volkan; Öztürk, Müjgan Tek; Nadir, Aydın; Musmul, Ahmet; Çavuşoğlu, Yüksel

doi:10.1177/1074248416657612

Cited by 4 publications

(3 citation statements)

References 41 publications

(36 reference statements)

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“…The only factor potentially associated with the beneficial effects of NTG found in the subgroup analysis was the existence of reduced LVEF (<50%). Indirect data have suggested that vasodilator therapy, including NTG, can improve ventricular function and heart failure biomarkers in patients with reduced LVEF, especially after myocardial infarction [26–28]. Therefore, the results of the present study will have to be confirmed by specifically designed studies.…”

Section: Discussionmentioning

confidence: 76%

Evaluation of the effect of intravenous nitroglycerine on short-term survival of patients with acute heart failure according to congestion and perfusion status at emergency department arrival

Miró

Espinosa²,

Gil

et al. 2022

European Journal of Emergency Medicine

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Objectives: We investigated if the phenotypic classification of acute heart failure (AHF) based on the number of signs/ symptoms of congestion and hypoperfusion at emergency department (ED) arrival identifies subgroups in which intravenous (IV) nitroglycerine (NTG) use improves shortterm survival.Methods: We included consecutive AHF patients diagnosed in 45 Spanish EDs, who were grouped according to phenotype severity. The main outcome was 30-day all-cause death. Propensity scores (PS) for NTG use were generated using variables associated with death. Analysis of interaction was performed in subgroups of patients based on congestion, hypoperfusion, age, sex, coronary artery disease (CAD), left ventricular ejection fraction (LVEF) and SBP.Results: We analyzed 16 437 AHF patients (median = 83 years; women = 56%); 1882 received NTG (11.4%). In the whole cohort, the cumulative 30-day mortality in patients receiving NTG was higher (11.5% vs. 9.6%; unadjusted HR, 1.19; 95% CI, 1.04-1.36), but not in the PS-matched cohorts (1698 pairs of patients; 11.5% vs. 10.5%; HR, 1.10; 95% CI, 0.90-1.35). Mortality was increased in NTG-treated patients with mild congestion (HR, 2.09; 95% CI, 1.19-3.67), especially in those without hypoperfusion (HR, 2.51; 95% CI, 1.24-5.10). Interaction analysis of the PS-matched cohorts confirmed detrimental effects of NTG use in less congested patients, whereas beneficial effects were only observed in patients with decreased LVEF (<50% subgroup: HR, 0.59; 95% CI, 0.37-0.92; ≥50% subgroup: HR, 1.30; 95% CI, 0.66-2.56; P = 0.002). Conclusion: Phenotypical classification of AHF based on congestion/ hypoperfusion at ED arrival does not identify subgroups of patients in whom IV-NTG would decrease mortality, although it could potentially be beneficial in those with LVEF of less than 50%. This hypothesis will have to be confirmed in the future. Conversely, our results suggest that IV-NTG may be harmful in patients with only mild clinical congestion.

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Section: Discussionmentioning

confidence: 76%

Evaluation of the effect of intravenous nitroglycerine on short-term survival of patients with acute heart failure according to congestion and perfusion status at emergency department arrival

Miró

Espinosa²,

Gil

et al. 2022

European Journal of Emergency Medicine

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“…In this retrospective study, the effects of levosimendan, dobutamine and vasodilator treatment on ongoing myocardial injury in acute decompensated heart failure were compared. In the results section, it was reported that hsCRP increased from 43 ng/ml to 67 ng/ml at the 48 th h subsequent to levosimendan administration [23].…”

Section: Discussionmentioning

confidence: 99%

The effects of levosimendan use on high-sensitivity C-reactive protein in patients with decompensated heart failure

Korkmaz¹,

Yılmaz²

2019

Arch Med Sci Atheroscler Dis

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Introduction The present study was intended to investigate the effect of levosimendan on high-sensitivity C-reactive protein (hsCRP) levels in hospitalized patients with decompensated heart failure. Material and methods The present study was designed as a prospective controlled clinical trial. A total of 50 patients with decompensated heart failure who were admitted to our hospital were included in the present study. Patients with stage III–IV heart failure based on the New York Heart Association, with systolic blood pressure > 100 mm Hg and with left ventricular ejection fraction of < 35%, were selected for the study population. The selected patients were divided into groups, levosimendan and furosemide. Results There was no significant difference between the groups based on demographics, basal echocardiographic and basal laboratory data. No difference was determined in basal hsCRP (mg/l) levels between the group admitted levosimendan infusion and the furosemide group (9.99 ±6.2, 9.23 ±6.4, p = 0.66). However, the hsCRP levels measured at the 24 th h (38.34 ±32.1 vs. 12.97 ±12.3, p < 0.001), the 48 th h (31.13 ±29.9 vs. 12.44 ±10.1, p = 0.003) and the 72 nd h (27.41 ±26.9 vs. 9.89 ±8.4, p = 0.002) were significantly higher in the levosimendan infusion group than the furosemide group. Conclusions It was found that hsCRP levels were significantly higher in the levosimendan infusion group than the furosemide group. Such an outcome could be related to myocyte injury and/or the amplification of the inflammatory response due to levosimendan.

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“…Since 2000, levosimendan has been used to treat patients with acute decompensated heart failure (ADHF), because it produces safe hemodynamic stabilization [ 1 ]. Levosimendan promotes inotropy by sensitizing cardiac muscle troponin C (cTnC) to Ca 2+ [ 2 , 3 ]. In addition, it causes vasodilatation by activating ATP-dependent-K + channels on smooth muscle.…”

Section: Introductionmentioning

confidence: 99%

Use of levosimendan combined with Shenfu injection to treat acute heart failure patients with hypotension: a prospective randomized controlled single-blind study

Zhang

Wan

et al. 2022

BMC Cardiovasc Disord

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Background Levosimendan can improve clinical symptoms and the cardiorenal rescue success rate, and stabilize hemodynamic parameters in individuals suffering from acute decompensated heart failure. In addition, Shenfu injection (SFI) has been shown to protect the ischemic heart and enhance myocardial contractility. Methods For this randomized control single-blind study, 101 patients with acute decompensated heart failure (ADHF) were enrolled and randomly assigned to control levosimendan (n = 51) and levosimendan + SFI injection (n = 50) groups. Attending physicians were not blinded for which arm the patients were allocated. Blood pressure, heart rate, the electrocardiogram, respiratory rate, fluid intake and urine output were all recorded 2 h and 24 h after drug infusions had commenced, and the cardiac index (CI) was monitored by ultrasonic cardiac output monitors. Results Median blood pressure was markedly increased in the levosimendan + SFI group after 2 h and 24 h from the initiation of infusions compared to levosimendan administration alone. Brain natriuretic peptide (BNP) concentrations were reduced after administrations of levosimendan + SFI or solely levosimendan (both P < 0.001). Alterations in BNP concentrations were not different in the combination and control groups. No differences were found between the 2 groups in heart rate or severe hypotension, but blood pressure (systolic blood pressure, diastolic blood pressure) and hemodynamic parameters including CI, cardiac output and stroke volume index responded better in the levosimendan + SFI group compared to the monotherapy levosimendan group. Conclusions Levosimendan + SFI was superior to treat ADHF patients compared to levosimendan monotherapy and produced significant improvements in hemodynamic parameters especially for ADHF patients with hypotension. Trail registration The study was prospectively registered at Chinese Clinical Trial Registry with registration number [ChiCTR2000039385] (10/25/2020).

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Comparison of the Effects of Levosimendan Dobutamine and Vasodilator Therapy on Ongoing Myocardial Injury in Acute Decompensated Heart Failure

Cited by 4 publications

References 41 publications

Evaluation of the effect of intravenous nitroglycerine on short-term survival of patients with acute heart failure according to congestion and perfusion status at emergency department arrival

Evaluation of the effect of intravenous nitroglycerine on short-term survival of patients with acute heart failure according to congestion and perfusion status at emergency department arrival

The effects of levosimendan use on high-sensitivity C-reactive protein in patients with decompensated heart failure

Use of levosimendan combined with Shenfu injection to treat acute heart failure patients with hypotension: a prospective randomized controlled single-blind study

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