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Hu Y, Wei Z, Zhang C, Lu C, Zeng Z. The effect of levosimendan on right ventricular function in patients with heart dysfunction: a systematic review and meta-analysis. Sci Rep 2021; 11:24097. [PMID: 34916560 PMCID: PMC8677770 DOI: 10.1038/s41598-021-03317-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 12/01/2021] [Indexed: 11/11/2022] Open
Abstract
Levosimendan exerts positive inotropic and vasodilatory effects. Currently, its effects on right heart function remain uncertain. This systematic review and meta-analysis is intended to illustrate the impacts of levosimendan on systolic function of the right heart in patients with heart dysfunction. We systematically searched electronic databases (PubMed, the Cochrane Library, Embase and Web of Science) up to November 30, 2020, and filtered eligible studies that reported the impacts of levosimendan on right heart function. Of these, only studies whose patients suffered from heart dysfunction or pulmonary hypertension were included. Additionally, patients were divided into two groups (given levosimendan or not) in the initial research. Then, RevMan5.3 was used to conduct further analysis. A total of 8 studies comprising 390 patients were included. The results showed that after 24 h of levosimendan, patients' right ventricular fractional area change [3.17, 95% CI (2.03, 4.32), P < 0.00001], tricuspid annular plane systolic excursion [1.26, 95% CI (0.35, 2.16), P = 0.007] and tricuspid annular peak systolic velocity [0.86, 95% CI (0.41, 1.32), P = 0.0002] were significantly increased compared to the control group. And there is an increasing trend of cardiac output in levosimendan group [1.06, 95% CI (- 0.16, 2.29), P = 0.09 ] .Furthermore, patients' systolic pulmonary arterial pressure [- 5.57, 95% CI (- 7.60, - 3.54), P < 0.00001] and mean pulmonary arterial pressure [- 1.01, 95% CI (- 1.64, - 0.37), P = 0.002] were both significantly decreased, whereas changes in pulmonary vascular resistance [- 55.88, 95% CI (- 206.57, 94.82), P = 0.47] were not significant. Our study shows that in patients with heart dysfunction, levosimendan improves systolic function of the right heart and decreases the pressure of the pulmonary artery.
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Affiliation(s)
- Yaoshi Hu
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
- Guangxi Key Laboratory of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention, Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning, 530021, Guangxi, China
| | - Zhe Wei
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Chaoyong Zhang
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
- Guangxi Key Laboratory of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention, Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning, 530021, Guangxi, China
| | - Chuanghong Lu
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
- Guangxi Key Laboratory of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention, Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning, 530021, Guangxi, China
| | - Zhiyu Zeng
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China.
- Guangxi Key Laboratory of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention, Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning, 530021, Guangxi, China.
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Li YH, Li W, Cui QL, Su XJ. Shenfu injection combined with levosimendan for treatment of patients with chronic heart failure: Impact on gastrointestinal hormones and heart function. Shijie Huaren Xiaohua Zazhi 2018; 26:454-459. [DOI: 10.11569/wcjd.v26.i7.454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the effect of Shenfu injection combined with levosimendan on gastrointestinal hormones and heart function in patients with chronic heart failure.
METHODS One hundred and twenty-four patients with chronic heart failure treated from October 2015 to December 2016 were randomly divided into either an observation group or a control group. The control group was given leosimendan alone, and the observation group was given levosimendan plus Shenfu injection. Two weeks after therapy, gastrointestinal hormones, heart function, adverse reactions, and clinical efficacy were compared between the two groups.
RESULTS The effective rate was significantly higher in the observation group than in the control group (91.94% vs 79.03%, χ2 = 4.159, P < 0.05). Serum gastrin and motilin levels were significantly higher in the observation group than in the control group (103.12 ng/mL ± 14.25 ng/mL vs 91.45 ng/mL ± 12.10 ng/mL, 305.62 ng/mL ± 41.21 ng/mL vs 262.12 ng/mL± 35.46 ng/mL, t = 4.915, 6.300, P < 0.05). Left ventricular end-diastolic volume and left ventricular end-systolic volume were significantly lower, and left ventricular ejection fraction was significantly higher in the observation group than in the control group (105.45 mL ± 13.12 mL vs 124.45 mL ± 16.21 mL, 46.25 mL ± 7.12 mL vs 57.14 mL ± 7.65 mL, 52.45% ± 7.12% vs 45.12% ± 7.45%, t = 7.174, 8.205, 5.601, P < 0.05). The rate of complications such as dizziness, low blood pressure, and sinus bradycardia was significantly lower in the observation group than in the control group (4.84% vs 16.13%, χ2 = 4.211, P < 0.05).
CONCLUSION Shenfu injection combined with levosimendan can help improve heart function in patients with chronic heart failure, enhance the clinical curative effect, and reduce the adverse reactions, which may be related to regulating gastrointestinal hormones.
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Sanfilippo F, Knight JB, Scolletta S, Santonocito C, Pastore F, Lorini FL, Tritapepe L, Morelli A, Arcadipane A. Levosimendan for patients with severely reduced left ventricular systolic function and/or low cardiac output syndrome undergoing cardiac surgery: a systematic review and meta-analysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:252. [PMID: 29047417 PMCID: PMC5648477 DOI: 10.1186/s13054-017-1849-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 09/28/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Previous studies have shown beneficial effects of levosimendan in high-risk patients undergoing cardiac surgery. Two large randomized controlled trials (RCTs), however, showed no advantages of levosimendan. METHODS We performed a systematic review and meta-analysis (MEDLINE and Embase from inception until March 30, 2017), investigating whether levosimendan offers advantages compared with placebo in high-risk cardiac surgery patients, as defined by preoperative left ventricular ejection fraction (LVEF) ≤ 35% and/or low cardiac output syndrome (LCOS). The primary outcomes were mortality at longest follow-up and need for postoperative renal replacement therapy (RRT). Secondary postoperative outcomes investigated included myocardial injury, supraventricular arrhythmias, development of LCOS, acute kidney injury (AKI), duration of mechanical ventilation, intensive care unit and hospital lengths of stay, and incidence of hypotension during drug infusion. RESULTS Six RCTs were included in the meta-analysis, five of which investigated only patients with LVEF ≤ 35% and one of which included predominantly patients with LCOS. Mortality was similar overall (OR 0.64 [0.37, 1.11], p = 0.11) but lower in the subgroup with LVEF < 35% (OR 0.51 [0.32, 0.82], p = 0.005). Need for RRT was reduced by levosimendan both overall (OR 0.63 [0.42, 0.94], p = 0.02) and in patients with LVEF < 35% (OR 0.55 [0.31, 0.97], p = 0.04). Among secondary outcomes, we found lower postoperative LCOS in patients with LVEF < 35% receiving levosimendan (OR 0.49 [0.27, 0.89], p = 0.02), lower overall AKI (OR 0.62 [0.42, 0.92], p = 0.02), and a trend toward lower mechanical support, both overall (p = 0.07) and in patients with LVEF < 35% (p = 0.05). CONCLUSIONS Levosimendan reduces mortality in patients with preoperative severely reduced LVEF but does not affect overall mortality. Levosimendan reduces the need for RRT after high-risk cardiac surgery.
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Affiliation(s)
- Filippo Sanfilippo
- Department of Anesthesia and Intensive Care, Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione (IRCCS-ISMETT), Via Tricomi 5, 90127, Palermo, Italy.
| | - Joshua B Knight
- Department of Anesthesia and Intensive Care, Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione (IRCCS-ISMETT), Via Tricomi 5, 90127, Palermo, Italy.,Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sabino Scolletta
- Unit of Anesthesia and Critical Care Medicine, Department of Medical Biotechnologies, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Cristina Santonocito
- Department of Anesthesia and Intensive Care, Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione (IRCCS-ISMETT), Via Tricomi 5, 90127, Palermo, Italy
| | - Federico Pastore
- Department of Anesthesia and Intensive Care, Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione (IRCCS-ISMETT), Via Tricomi 5, 90127, Palermo, Italy
| | - Ferdinando L Lorini
- Department of Anaesthesia and Intensive Care, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Luigi Tritapepe
- Department of Cardiovascular, Respiratory, Nephrological, Anaesthetic and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | - Andrea Morelli
- Department of Anesthesiology and Intensive Care, Policlinico Umberto 1, Sapienza University of Rome, Rome, Italy
| | - Antonio Arcadipane
- Department of Anesthesia and Intensive Care, Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione (IRCCS-ISMETT), Via Tricomi 5, 90127, Palermo, Italy
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