Clinical observation of intermittently repeated application of levosimendan in the treatment of right heart failure of pulmonary hypertension / 中国药房

ABSTRACT

OBJECTIVE To observe th e efficacy and safety of intermittently repeated application of levosimendan in the treatment of right heart failure of pulmonary hypertension. METHODS A total of 70 cases of right heart failure of pulmonary hypertension were collected from the First Affiliated Hospital of Guangxi Medical University during Jan. 2019-May 2021，and then randomly divided into control group and observation group ，with 35 cases in each group.In control group ，the patients with moderate risk of classification of pulmonary hypertension were given Tadalafil tablets and Ambrisentan tablets ，while the patients with high risk were given Tadalafil tablets ，Ambrisentan tablets and Treprostinil injection ；both were given anti-right heart failure drugs at the same time. On the basis of treatment in the control group ，patients in the observation group were additionally intravenously pumped with levosimendan injection 12.5 mg，once a month ，at a rate of 0.05-0.1 μg/（kg·min），3 months in total. Response rate of therapy ，improvement of risk stratification of pulmonary hypertension after treatment ，and average pulmonary artery pressure ，six-minute walk distance （6MWD），serum level of N-terminal pro brain natriuretic peptide （NT-proBNP），right atrial pressure （RAP），oxygen saturation in mixed venous blood （SvO2），cardiac index （CI），right ventricular ejection fraction （RVEF），early diastolic tricuspid inflow velocity/early diastolic tricuspid annular velocity （E/Ea），tricuspid annular plane systolic excursion（TAPSE），right ventricular end-diastolic diameter （RVEDD），right ventricular end-systolic diameter （RVESD）before and after treatment ，and the occurrence of adverse reactions were observed in 2 groups. RESULTS The total response rate of observation group was significantly higher than control group after treatment （P＜0.05）. After treatment ，average pulmonary artery pressure，NT-proBNP level ，RAP，E/Ea，RVEDD and RVESD of 2 groups were significantly lower than before treatment ，while 6MWD，SvO2， CI， TAPSE and RVEF were significantly higher than before treatment ；NT-proBNP level and E/Ea of observation group were significantly lower than control group ， while 6MWD，CI，TAPSE and RVEF were significantly higher than control group （P＜0.05 or P＜0.01）. There was no significant difference in average pulmonary artery pressure ， risk stratification improvement cases of pulmonary hypertension ， RAP， SvO2， RVEDD， RVESD and the incidence of asymptomatic hypotension between 2 groups（P＞0.05）. CONCLUSIONS Intermittently repeated application of levosimendan can improve the function of right heart of pulmonary hypertension complicated with right heart failure and has good safety.