Assessment of sustained effects of levosimendan on right ventricular systolic functions in patients with advanced heart failure

The effect of levosimendan on right ventricular function in patients with heart dysfunction: a systematic review and meta-analysis

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.

Shenfu injection combined with levosimendan for treatment of patients with chronic heart failure: Impact on gastrointestinal hormones and heart function

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.

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

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.