AIM To explore the therapeutic effect of levosimendan in patients with left heart failure combined with pulmonary hypertension and provide new reference for the treatment of such patients.
METHODS Patients diagnosed with left ventricular dysfunction combined with pulmonary hypertension who visited the Affiliated Hospital of Guizhou Medical University from January 2021 to December 2021 were collected as the research subjects. Thirty-two patients treated with levosimendan were assigned to the study group and fifty-eight patients selected using propensity score matching served as the control group. Relevant data were collected and analyzed using appropriate statistical methods.
RESULTS Compared with the control group during the same period, the study group showed a significant decrease in brain natriuretic peptide levels after treatment (P<0.01); Creatine kinase was significantly reduced (P<0.05). Compared with before treatment in the same group, the control group and study group showed a decrease in NT proBNP and creatine kinase (both P<0.01), as well as a decrease in systolic blood pressure, diastolic blood pressure, and heart rate (all P<0.05). Compared with the control group during the same period, the study group showed an increase in LVEF (P<0.01), a decrease in interventricular septal thickness, left ventricular posterior wall thickness, main pulmonary artery diameter, and right atrial anterior posterior diameter (all P<0.01), a decrease in peak tricuspid regurgitation velocity (P<0.05), and a decrease in pulmonary arterial systolic pressure for mild (P<0.05), moderate (P<0.01), and severe (P<0.01) pulmonary hypertension after treatment. Compared with before treatment in the same group, the control group and study group had an increase in LVEF (both P<0.01), a decrease in peak tricuspid regurgitation velocity (P<0.05), and a decrease in pulmonary arterial systolic pressure in mild (P<0.05), moderate (P<0.01), and severe (P<0.01) pulmonary hypertension. The total number of adverse events in the research group was lower than that in the control group one month after discharge, (P<0.05). At 3 months after discharge, the control group showed significantly higher levels of chest tightness and shortness of breath compared to the study group, (P<0.01); In the control group, patients with bilateral lower limb edema showed significant hypertension in the study group, (P<0.05); The readmission hospitalization rate is higher than that of the study group,(P<0.05), The total number of cases in the control group was also higher than that in the study group (P<0.01). The incidence of adverse events in the study group within 12 weeks was lower than that in the control group, (P<0.05). Univariate analysis suggested that smoking, drinking, coronary heart disease, atrial fibrillation, diabetes, hypertension were related risk factors. Multivariate analysis showed that the risk of patients with coronary heart disease, diabetes and atrial fibrillation was 3.8, 3.4 and 11.3 times higher than that of their corresponding normal patients. There is no significant difference between Grade 1 hypertension and normal hypertension patients in hypertension, while Grade 2 and Grade 3 hypertension have a 3-fold and 8-fold higher risk compared to normal patients, respectively.
CONCLUSION Levosimendan improves left ventricular function and reduces pulmonary artery pressure and the incidence of short-term adverse events in patients with heart failure with reduced ejection fraction combined with pulmonary hypertension. Factors affecting the treatment effect of levosimendan include coronary heart disease, hypertension, diabetes and atrial fibrillation.
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