Effectiveness of Levosimendan versus Dobutamine for the Patients with Severe Valvular Disease in Perioperative Period: A Randomized Controlled Trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 HUANGYuan-qin , LIYing , WEIYu , LIUBin , XUWei-jiang

Intensive Care Unit, Wuhan Asia Heart Hospital, Wuhan 430023, P. R. China;

Corresponding author：

HUANGYuan-qin, Email: huangyq77@sohu.com

Keywords：

Levosimendan; Dobutamine; Severe valvular disease; Perioperative period

DOI：

10.7507/1007-4848.20150112

Video：

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Objective To explore the effectiveness of levosimendan versus dobutamine for the patients with severe valvular disease in perioperative period. Methods A randomized, single-blind, and controlled study was conducted in 59 patients with severe valvular disease in perioperative period. There were 48 males and 11 females at average age of 51±14 years (ranged from 18 to 70 years). The patients received Swan-Ganz catheterization with pulmonary capillary wedge pressure (PCWP)≥15 mm Hg, cardiac index (CI)≤2.5 L/(min·m²), and hemodynamic stability. They were divided into a levosimendan group (n=25) and a dobutamine group (n=34) to receive levosimendan or dobutamine injection intravenously for 24 hours on base of anti-heart failure treatment by random digital table. Results In the levosimendan group, the level of PCWP was lower than the baseline level with a statistical difference(12.51±8.76 mm Hg vs. 20.11±8.04 mm Hg, P < 0.01) after 24 hours' treatment, and the level of CI was higher than the baseline level with a statistical difference (2.58±0.72 L/(min·m²) vs. 2.01±0.54 L/(min·m²), P < 0.05) after 24 hours' treatment. In the levosimendan group, the changes of pulmonary capillary wedge pressure (PCWP), pulmonary arterial mean pressure (PAMP), sequential vascular response (SVR), and left ventricular ejection fraction (LVEF) were more obvious compared with those in the dobutamine group with statistical differences (all P < 0.05) after 24 hours' treatment. The offline time and ICU stay in the levosimendan group reduced compared with those of the dobutamine group with statistical differences (47.3±10.4 h vs. 52.5±7.6 h, P < 0.05; 5.3±2.2 d vs. 6.8±3.5 d, P < 0.05). There was no statistical difference in the incidence of adverse events between the two groups (P > 0.05). Conclusion Compared with dobutamine, levosimendan can improve hemodynamic stability of patients with severe valvular disease in perioperative period with good tolerability and safety.

Citation： HUANGYuan-qin, LIYing, WEIYu, LIUBin, XUWei-jiang. Effectiveness of Levosimendan versus Dobutamine for the Patients with Severe Valvular Disease in Perioperative Period: A Randomized Controlled Trial. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(5): 423-427. doi: 10.7507/1007-4848.20150112 Copy

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3.	Kamath SR, Jaykumar I, Matha S. Levosimendan. J Indian Pediatr, 2009, 46(7):593-596.
4.	Barilla F, Giordano F, Jacomelli I, et al. ST-segment elevation during levosimendan infusion. J Cardiovasc Med (Hagerstown), 2012, 13(7):454-456.
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11.	Nieminen M. Levosimendan in patients with lef heart failure afer acute myocardial infarction-review of the russlan study and future developments with levosimenda. J Fur Kardiologie, 2011, 9(10):45-48.
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13.	毛懿, 杨宏, 张炜, 等.急性失代偿充血性心力衰竭患者氨基端脑钠肽前体水平与血流动力学参数间的相关性分析.中华老年多器官疾病杂志, 2012, 11(1):46-49.
14.	李元建, 主编.药理学.北京:高等教育出版社, 2008. 169.
15.	阙俐.左西孟旦治疗急性心衰的发展前景.国外医药(合成药生化药制剂分册), 2000, 21(6):370-371.
16.	中华医学会心血管病学分会, 中华心血管病杂志编辑委员会.慢性心力衰竭诊断治疗指南.中华心血管病杂志, 2007, 35(12):1076-1094.
17.	纪木火, 李仁奇, 张庆伟, 等, 钙增敏剂左西孟旦的研究进展.药学与临床研究, 2010, 18(5):23-24.
18.	周占林, 徐坚, 王宁夫, 等.心肺运动试验对冠心病的诊断价值.[2009]年钱江国际心血管病会议暨浙江省心血管年会论文汇编, 2009. 55-57.
19.	Fotbolcu H, Duman D. A promising new inotrope:levosimenda. J Anadolu Kardiyol Derg, 2010, 10(2):176-182.
20.	Gui J, Yue Y, Chen R, et al. A20(TNFAIP3) alleviates CVB3-induced myocarditis via inhibiting NF-kappa B signaling. PLoS One, 2012, 7(9):e46515.

1. Parissis JT, Rafouli-Stergiou P, Paraskevaidis I, et al. Levosimendan:from basic science to clinical practice. J Heart Fail Rev, 2009, 14(4):265-275.
2. Antila S, Sundberg S, Lehtonen LA. Clinical pharmacology of levosimendan. J Clin Pharmacokinet, 2007, 46(7):535-552.
3. Kamath SR, Jaykumar I, Matha S. Levosimendan. J Indian Pediatr, 2009, 46(7):593-596.
4. Barilla F, Giordano F, Jacomelli I, et al. ST-segment elevation during levosimendan infusion. J Cardiovasc Med (Hagerstown), 2012, 13(7):454-456.
5. 刘洋, 张静.左西孟旦治疗慢性心衰急性加重期患者的疗效观察.山东医药, 2011, 51(45):104.
6. 王雷, 崔亮, 魏嘉平, 等.静脉注射左西孟旦治疗重度失代偿性心力衰竭患者的疗效分析.中华心血管病杂志, 2010, 6(38):527-530.
7. 张明惠, 杜新平, 李玉芬.左西孟旦在难治性心力衰竭中的应用.山东医药, 2012, 52(1):76-77.
8. 陈桂荣, 谢世全, 韩瑞鸿.钙增敏剂左西孟旦的研究新进展.辽宁中医药大学学报, 2011, 13(3):198-199.
9. Baba Y, Kuto T, Kitaoka H, et al. Usefulness of high-sensitive cardiac troponin T for evaluating the activity of cardiac sarcoidosis. J Int Heart J, 2012, 53(5):287-292.
10. Giannitsis E, Katus HA. Biomarkers:Pros and cons of highsensitivity assays for cardiac troponin. J Nat Rev Cardiol, 2012, 9(11):616-618.
11. Nieminen M. Levosimendan in patients with lef heart failure afer acute myocardial infarction-review of the russlan study and future developments with levosimenda. J Fur Kardiologie, 2011, 9(10):45-48.
12. Gollapudi S, Mamidi R, Mallampalli L, et al. The N-terminal extension of cardiac troponin T stabilizes the blocked state of cardiac thin flament. J Biophys J, 2012, 103(5):940-948.
13. 毛懿, 杨宏, 张炜, 等.急性失代偿充血性心力衰竭患者氨基端脑钠肽前体水平与血流动力学参数间的相关性分析.中华老年多器官疾病杂志, 2012, 11(1):46-49.
14. 李元建, 主编.药理学.北京:高等教育出版社, 2008. 169.
15. 阙俐.左西孟旦治疗急性心衰的发展前景.国外医药(合成药生化药制剂分册), 2000, 21(6):370-371.
16. 中华医学会心血管病学分会, 中华心血管病杂志编辑委员会.慢性心力衰竭诊断治疗指南.中华心血管病杂志, 2007, 35(12):1076-1094.
17. 纪木火, 李仁奇, 张庆伟, 等, 钙增敏剂左西孟旦的研究进展.药学与临床研究, 2010, 18(5):23-24.
18. 周占林, 徐坚, 王宁夫, 等.心肺运动试验对冠心病的诊断价值.[2009]年钱江国际心血管病会议暨浙江省心血管年会论文汇编, 2009. 55-57.
19. Fotbolcu H, Duman D. A promising new inotrope:levosimenda. J Anadolu Kardiyol Derg, 2010, 10(2):176-182.
20. Gui J, Yue Y, Chen R, et al. A20(TNFAIP3) alleviates CVB3-induced myocarditis via inhibiting NF-kappa B signaling. PLoS One, 2012, 7(9):e46515.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effectiveness of Levosimendan versus Dobutamine for the Patients with Severe Valvular Disease in Perioperative Period: A Randomized Controlled Trial

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