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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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.	劉洋, 張靜.左西孟旦治療慢性心衰急性加重期患者的療效觀察.山東醫藥, 2011, 51(45):104.
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7.	張明惠, 杜新平, 李玉芬.左西孟旦在難治性心力衰竭中的應用.山東醫藥, 2012, 52(1):76-77.
8.	陳桂榮, 謝世全, 韓瑞鴻.鈣增敏劑左西孟旦的研究新進展.遼寧中醫藥大學學報, 2011, 13(3):198-199.
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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, 楊宏, 張煒, 等.急性失代償充血性心力衰竭患者氨基端腦鈉肽前體水平與血流動力學參數間的相關性分析.中華老年多器官疾病雜志, 2012, 11(1):46-49.
14.	李元建, 主編.藥理學.北京:高等教育出版社, 2008. 169.
15.	闕俐.左西孟旦治療急性心衰的發展前景.國外醫藥(合成藥生化藥制劑分冊), 2000, 21(6):370-371.
16.	中華醫學會心血管病學分會, 中華心血管病雜志編輯委員會.慢性心力衰竭診斷治療指南.中華心血管病雜志, 2007, 35(12):1076-1094.
17.	紀木火, 李仁奇, 張慶偉, 等, 鈣增敏劑左西孟旦的研究進展.藥學與臨床研究, 2010, 18(5):23-24.
18.	周占林, 徐堅, 王寧夫, 等.心肺運動試驗對冠心病的診斷價值.[2009]年錢江國際心血管病會議暨浙江省心血管年會論文匯編, 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. 劉洋, 張靜.左西孟旦治療慢性心衰急性加重期患者的療效觀察.山東醫藥, 2011, 51(45):104.
6. 王雷, 崔亮, 魏嘉平, 等.靜脈注射左西孟旦治療重度失代償性心力衰竭患者的療效分析.中華心血管病雜志, 2010, 6(38):527-530.
7. 張明惠, 杜新平, 李玉芬.左西孟旦在難治性心力衰竭中的應用.山東醫藥, 2012, 52(1):76-77.
8. 陳桂榮, 謝世全, 韓瑞鴻.鈣增敏劑左西孟旦的研究新進展.遼寧中醫藥大學學報, 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, 楊宏, 張煒, 等.急性失代償充血性心力衰竭患者氨基端腦鈉肽前體水平與血流動力學參數間的相關性分析.中華老年多器官疾病雜志, 2012, 11(1):46-49.
14. 李元建, 主編.藥理學.北京:高等教育出版社, 2008. 169.
15. 闕俐.左西孟旦治療急性心衰的發展前景.國外醫藥(合成藥生化藥制劑分冊), 2000, 21(6):370-371.
16. 中華醫學會心血管病學分會, 中華心血管病雜志編輯委員會.慢性心力衰竭診斷治療指南.中華心血管病雜志, 2007, 35(12):1076-1094.
17. 紀木火, 李仁奇, 張慶偉, 等, 鈣增敏劑左西孟旦的研究進展.藥學與臨床研究, 2010, 18(5):23-24.
18. 周占林, 徐堅, 王寧夫, 等.心肺運動試驗對冠心病的診斷價值.[2009]年錢江國際心血管病會議暨浙江省心血管年會論文匯編, 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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