Levosimendan Improves NT-proBNP Levels and Echocardiographic Parameters in Patients with Decompensated Heart Failure Submitted to Optimal Medical Therapy

Öz

OBJECTIVE: The effect of levosimendan on NT-proBNP levels and echocardiographic parameters in patients with decompensated heart failure receiving optimal medical therapy was evaluated.METHODS: The study included 30 patients with acute heart failure with New York Heart Association (NYHA) class IV. Although all patients had received standard heart failure therapy, they required support of an inotropic agent. They received bolus and maintenance infusion of levosimendan treatment for 24 hours. Echocardiography was performed before the levosimendan treatment and at the 5th day after the treatment. NT-proBNP levels were taken at 48th hour and 5th day.RESULTS: Levosimendan treatment (bolus+maintenance infusion) was performed in all patients without any interruption or complication. A significant reduction in NT-proBNP levels was observed at the end of 48th hour and 5th day compared to baseline values (p

Anahtar Kelimeler

• Heart failure, levosimendan; NT-proBNP; echocardiography

Levosimendan Optimal Medikal Tedavi Alan Dekompanse Kalp Yetersizliği Hastalarında NTproBNP Seviyesini ve Ekokardiyografik Parametreleri Düzeltir

Öz

AMAÇ: Optimal medikal tedavi alan dekompanse kalp yetersizliği hastalarında levosimendanın NT-proBNP seviyesi ve ekokardiyografik parametreler üzerindeki etkisi değerlendirilmiştir.YÖNTEMLER: Çalışmaya "New York Heart Association (NYHA)" Sınıf IV olan 30 akut kalp yetersizliği hastası dâhil edildi. Tüm hastalar standart kalp yetersizliği tedavisi almasına rağmen inotrop desteğe ihtiyaç duyuyordu. Hastalara 24 saat boyunca bolus ve idame infüzyon şeklinde levosimendan uygulandı. Levosimendan tedavisi öncesi ve tedavi sonrası 5. gün ekokardiyografi uygulandı. NT-proBNP seviyeleri 48. saat ve 5. gün çalışıldı.BULGULAR: Levosimendan tedavisi (bolus+idame) tüm hastalara kesintisiz ve komplikasyon gelişmeden verilebildi. Bazal bulgulara kıyasla 48. saat ve 5. gün sonunda NT-proBNP seviyelerinde önemli bir azalma sağlandı (p

Anahtar Kelimeler

• Kalp yetersizliği, levosimendan; NT-proBNP; ekokardiyografi

Kaynakça

1. Krum H, Liew D. New and emerging drug therapies for the management of acute heart failure. Intern Med J 2003;33:515-20.
2. Mebazaa A, Nieminen MS, Packer M, Cohen-Solal A, Kleber FX, Pocock SJ, Thakkar R, et al. Levosimendan vs dobutamine for patients with acute decompensated heart failure: the SURVIVE Randomized Trial. JAMA 2007;297:1883-91.
3. Fotbolcu H, Duman D. A promising new inotrope: levosimendan. Anadolu Kardiyol Derg 2010;10:176-82.
4. De Luca L, Mebazaa A, Filippatos G, Parissis JT, Böhm M, Voors AA, et al. Overview of emerging pharmacologic agents for acute heart failure syndromes. Eur J Heart Fail 2008;10:201-13.
5. Hasenfuss G, Pieske B, Castell M, Kretschmann B, Maier LS, Just H. Influence of the novel inotropic agent levosimendan on isometric tension and calcium cycling in failing human myocardium. Circulation 1998;98:2141-7.
6. Yildiz O. Vasodilating mechanisms of levosimendan: involvement of Kþ channels. J Pharmacol Sci 2007;104:1-5.
7. Lilleberg J, Sundberg S, Häyhä M, Akkila J, Nieminen MS. Haemodynamic dose-efficacy of levosimendan in healthy volunteers. Eur J Clin Pharmacol 1994;47:267-74.
8. Takahashi R, Talukder MA, Endoh M. Inotropic effects of OR-1896, an active metabolite of levosimendan, on canine ventricular myocardium. Eur J Pharmacol 2000;400:103-12.

9. Ukkonen H, Saraste M, Akkila J, Knuuti J, Karanko M, Iida H, et al. Myocardial efficiency during levosimendan infusion in congestive heart failure. Clin Pharmacol Ther 2000;68:522-31.
10. Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 2009;22:107-33.
11. Ho KK, Pinsky JL, Kannel WB, Levy D. The epidemiology of heart failure: the Framingham Study. J Am Coll Cardiol 1993;22:6A-13A.
12. Stevenson LW. Are hemodynamic goals viable in tailoring heart failure therapy? Hemodynamic goals are relevant. Circulation 2006;113:1020-7.
13. Zafrir B, Amir O. Beta blocker therapy, decompensated heart failure, and inotropic interactions: current perspectives. Isr Med Assoc J 2012;14:184-9.
14. Mebazaa A, Nieminen MS, Filippatos GS, Cleland JG, Salon JE, Thakkar R, et al. Levosimendan vs. dobutamine: outcomes for acute heart failure patients on β-blockers in SURVIVE. Eur J Heart Fail 2009;11: 304-11.
15. Kirlidis TT, Skoularigis KT, Karayiannis G, Karayiannis G, Tsaknakis TK, Triposkiadis F. The influence of β-blockade on the hemodynamic effects of levosimendan in elderly (≥70 years) patients with acutely decompensated systolic heart failure. Int J Clin Pharmacol Ther 2009;47:454-9.
16. Duygu H, Turk U, Ozdogan O, Akyuz S, Kirilmaz B, Alioglu E, et al. Levosimendan versus dobutamine in heart failure patients treated chronically with carvedilol. Cardiovasc Ther 2008;26:182-8.
17. Bergh CH, Andersson B, Dahlström U, Forfang K, Kivikko M, Sarapohja T, et al. Intravenous levosimendan vs. dobutamine in acute decompensated heart failure patients on beta-blockers. Eur J Heart Fail 2010;12:404-10.
18. Marwick TH. Clinical applications of tissue Doppler imaging: A promise fulfilled. Heart 2003;89:1377-8.
19. Põder P, Eha J, Sundberg S, Antila S, Heinpalu M, Loogna I, et al. Pharmacodynamics and pharmacokinetics of oral levosimendan and its metabolites in patients with severe congestive heart failure: a dosing interval study. J Clin Pharmacol 2004;44:1143-50.
20. Aidonidis G, Kanonidis I, Koutsimanis V, Neumann T, Erbel R, Sakadamis G. Efficiency and safety of prolonged levosimendan infusion in patients with acute heart failure. Cardiol Res Pract 2011;2011:342302.
21. Paksoy F, Ulaş T, Tursun I, Dal MS, Oztekin E, Borlu F. (The effect of levosimendan and dobutamine treatment on QT dispersion in patients with decompensated heart failure: a prospective study). Anadolu Kardiyol Derg 2012;12:16-22.
22. Parissis JT, Rafouli-Stergiou P, Paraskevaidis I, Mebazaa A. Levosimendan: from basic science to clinical practice. Heart Fail Rev 2009;14:265-75.
23. Cavusoglu Y. The use of levosimendan in comparison and in combination with dobutamine in the treatment of decompensated heart failure. Expert Opin Pharmacother 2007;8:665-77.
24. Cohen-Solal A, Logeart D, Huang B, Cai D, Nieminen MS, Mebazaa A. Lowered B-type natriuretic peptide in response to levosimendan or dobutamine treatment is associated with improved survival in patients with severe acutely decompensated heart failure. J Am Coll Cardiol 2009;53:2343-8.
25. Parissis J, Farmakis D, Bistola V, Adamopoulos S, Kremastinos DT. Levosimendan for the treatment of acute heart failure syndromes: time to identify subpopulations of responding patients. Am J Cardiol 2007;99:146-7.