Therapeutic effects of levosimendan and milrinone on AHF patients and their influence on serum levels of NT-proBNP , NE and ET-1 / 心血管康复医学杂志

ABSTRACT

Objective:To explore therapeutic effect of levosimendan and milrinone on patients with acute heart failure (AHF) ,and analyze their influence on serum levels of neurohormone factors and safety .Methods:A total of 160 AHF patients treated in our hospital from Jan 2013 to Aug 2016 were selected .According to random number table , they were randomly and equally divided into levosimendan group and milrinone group ,both groups received routine treatment for 7d .Therapeutic effect and incidence rate of adverse reactions ,left ventricular end-diastolic dimension (LVEDd) ,left ventricular ejection fraction (LVEF) ,left ventricular fractional shortening (LVFS) ,serum levels of N terminal pro brain natriuretic peptide (NT-proBNP) ,norepinephrine (NE) and endothelin-1 (ET-1) before and 7d after treatment ,mortality and rehospitalization rate within three-month follow-up were compared between two groups.Results: Total effective rate of levosimendan group was significantly higher than that of milrinone group (90.0% vs.71.3%) ,P＝0.003. Compared with before treatment after 7d treatment ,there were significant rise in LVEF and LVFS ,and significant reductions in LVEDd ,serum levels of NT-proBNP ,NE and ET-1 in two groups , P＜0.01 all ;compared with milrinone group after 7d treatment ,there were significant rise in LVEF [ (42.25 ± 6.71)% vs.(50.91 ± 6.43)% ] and LVFS [ (22.82 ± 5.56)% vs.(29.52 ± 4.37)% ] ,and significant reductions in serum levels of NT-proBNP [ (954 ± 334 ) pg/ml vs .(561 ± 286 ) pg/ml ] , NE [ (172.95 ± 31.84 ) pg/ml vs. (131.46 ± 25.59) pg/ml] and ET-1 [ (2.57 ± 0.44) pg/ml vs.(2.25 ± 0.34) pg/ml] in levosimendan group ,P＝0.001 all.After three-month follow-up ,there was no significant difference in mortality between two groups (P＝0.102) ,and rehospitalization rate of levosimendan group was significantly lower than that of milrinone group (6.25% vs.31.25%, P＝0.001).Incidence rate of adverse reactions of levosimendan group was significantly lower than that of milrinone group (8.75% vs.30.00%) , P＝0.001. Conclusion:Compared with milrinone ,levosimen-dan can more significantly improve clinical symptoms ,cardiac systolic function and reduce short-term rehospitaliza-tion rate and incidence rate of adverse reactions in AHF patients ,which is worth extending .