Clinical effects of levosimendan in patients with left ventricular systolic dysfunction under off-pump coronary artery bypass grafting

Abstract

Abstract: AIM: To investigate the clinical effect of levosimendan in patients with lower left ventricular eject fraction(LVEF) under off-pump coronary artery bypass grafting(CABG).METHODS: From May 2010 to November 2012, 40 cases with lower LVEF below 45% undergoing elective CABG were randomly devided into treatment group (20 cases) and control group (20 cases). All the cases received dopamine treatment perioperatively, and levosimendan were additionally used in the treatment group. The ICU time, the incidence of atrial fibrillation(AF),the duration of dopamine use, the mortality in the first 30 days were recorded. The level of LVEF in the first 3 days and the cTnI at 0,6,24,48 h after the operation were examined. RESULTS: No case died in both groups. Comparing with control group, treatment group had lower incidence of AF (P<0.05), and shorter time of dopamine use (P<0.05). Treatment group had a higher LVEF in the first two days than those in control group(P<0.05). Treatment group had lower cTnI at the 6h and 24h time point after the operation than those in control group(P<0.05). There was no remarkable difference between two groups in other aspects .CONCLUSION: Levosimendan has cardiac protection effect on patients under CABG with lower LVEF.

Key words: Levosimendan, Cardiac surgery, Coronary artery bypass grafting, Left ventricular ejection fraction, Systolic dysfunction

CLC Number:

R614

NIU Zhao-zhuo, SUN Li-xin, LIN Ming-shan, SUN Long, SHENG Wei, HOU Wen-ming, CHI Yi-fan. Clinical effects of levosimendan in patients with left ventricular systolic dysfunction under off-pump coronary artery bypass grafting[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2013, 18(10): 1160-1163.

References

[1] Christakis GT, Fremes SE, Naylor CD, et al. Impact of preoperative risk and perioperative morbidity on ICU stay following coronary bypass surgery[J]. Cardiovasc Surg,1996, 4(1): 29-35.
[2] De Santis V, Vitale D, Tritapepe L, et al. Use of levosimendan for cardiogenic shock in a patient with the apical ballooning syndrome[J]. Ann Intern Med, 2008,149(5): 365-367.
[3] Moiseyev VS, Poder P, Andrejevs N, et al. Safety and efficacy of a novel calcium sensitizer, levosimendan, in patients with left ventricular failure due to an acute myocardial infarction. A randomized, placebo-controlled, doubleblind study (RUSSLAN) [J]. Eur Heart J, 2002,23(18): 1422-1432.
[4] Russ MA, Prondzinsky R, Christoph A, et al. Hemodynamic improvement following levosimendan treatment in patients with acute myocardial infarction and cardiogenic shock[J]. Crit Care Med, 2007,35(12): 2732-2739.
[5] Lehmann A, Lang J, Boldt J, et al. Levosimendan in patients with cardiogenic shock undergoing surgical revascularization: a case series[J]. Med Sci Monit, 2002, 10(8):MT89-MT93.
[6] Pollesello P,Ovaska M,Kaivola J,et al. Binding of a new Ca²⁺ sensitizer,levosimendan,to recombinant human cardiac troponin C: a molecular modelling,fluorescence probe,and proton nuclear magnetic resonance study[J]. J Biol Chem,1994,269(46): 28584-28590.
[7] Kersten JR, Montgomery MW, Pagel PS, et al. Levosimendan , a new positive inotropic drug, decreases myocardial infarct size via activation of K_ATP channels[J]. Anesth Analg, 2000, 90(1) : 5-11.
[8] Sonntag S, Sundberg S, Lehtonen LA, et al. The calcium sensitizer levosimendan improves the function of stunned myocardium after percutaneous transluminal coronary angioplasty in acute myocardial ischemina[J]. J Am Coll Cardiol, 2004, 43( 12) : 2177-2182.
[9] Kaheinen P, Pollesello P, Levijoki J, et al. Effects of levosimendan and milrinone on oxygen consumption in isolated guinea-pig heart[J]. J Cardiovasc Pharmacol, 2004, 43( 4) : 555-561.
[10] Michaels AD, Mckeown B, Kostal M, et al. Effects of intravenous levosimendan on human coronary vasomotor regulation, left ventricular wall stress, and myocardial oxygen uptake [J]. Circulation, 2005, 111( 12) : 1504- 1509.
[11] Lilleberg J, Nieminen MS, Akkila J, et al. Effects of a new calcium sensitizer, levosimendan, on haemodynamics, coronary blood flow and myocardial substrate utilzation early after coronary artery bypass grafting[J]. Eur Heart J, 1998, 19( 4) : 660- 668.
[12] 苏丽军,白小涓,王标,等.左西孟旦注射液治疗充血性心力衰竭的疗效评价[J].中国医科大学学报,2008,32(2):263-266.
[13] 陈桂荣,谢世全,韩瑞鸿,等.钙增敏剂左西孟旦的研究新进展[J].辽宁中医药大学学报,2011,13(2):198-199.
[14] 王显悦,毕生辉,王晓武,等.左西孟旦治疗心脏术后左心室收缩功能低下[J].现代生物医学进展,2012,12(23):4464-4466.
[15] Etievent JP, Chocron S, Toubin G, et al. Use of cardiac troponin I as a marker of perioperative myocardial ischemia[J]. Ann Thorac Surg,1995,59(5): 1192-1194.
[16] 王德国, 储岳峰, 柯永胜, 等. 缺血预处理减轻心肌缺血再灌注诱导的 Na⁺-K⁺-ATP 酶异常表达[J]. 中国临床药理学与治疗学, 2007,12(1):47-51.