Levosimendan Efficacy in Patients with Myocardial Infarction and Chronic Cerebral Ischemia

For citation: Lebedeva N.B., Chesnokova L.Yu. Levosimendan Efficacy in Patients with Myocardial Infarction and Chronic Cerebral Ischemia. Doctor.Ru. 2020; 19(5): 19–23. (in Russian) DOI: 10.31550/1727-2378-2020-19-5-19-23
22 july 2020

Study Objective: to assess efficacy and safety of Levosimendan (LS) in patients with myocardial infarction (MI) complicated with left ventricular failure as a result of chronic cerebral ischemia (CCI).

Study Design: randomised study.

Materials and Methods. Examination included 182 patients with Q-positive MI and CCI with left ventricular ejection fraction (LVEF) of less than 40%: 149 (81.9%) males and 33 (18.1%) females aged 60.4 (53; 69) years old. Group I included 49 patients on standard therapy, and group II comprised 133 patients on LS. Subjects were examined by angioneurologist; they underwent echocardiography, colour duplex ultrasonography of brachiocephalic arteries (CDU BCA), cognitive tests, and 6-minute walk test.

Study Results. MI complications were recorded in 16 (32.7%) patients in group I and in 27 (20.3%) patients in group II. Hypotension was noted in 10 (20.4%) patients from group I and in 31 (23.3%) patients from group II; ventricular rhythm disturbances — in 15 (30.6%) and 34 (25.6%), hypokalemia — in 7 (14.3%) and 12 (9%) patients, respectively. LVEF before discharge in group I was 39.34% (37%; 43%), in group II — 44.7% (38%; 48%) (р = 0.007). Once LS was prescribed in group II, CDU BCA demonstrated 13.1% increase in internal carotid artery (ICA) diameter (р = 0.001), 25.1% increase in average blood velocity in ICA (р = 0.001); ICA resistance factor reduced by 12% (р = 0.001). Hospital admission lasted for 19.24 (17; 20) bed-days in group I and 15.21 (12; 18) bed-days in group II (р = 0.001).

Conclusion. Use of LS in MI resulting from CCI and complicated with atrial ventricular failure is safe, hemodynamically and clinically efficient and pharmacologically and economically feasible.

Contributions: Lebedeva, N.B. — study design, data interpretation and aggregation, review of critically important material, final manuscript approval; Chesnokova, L.Yu. — collection of clinical materials, statistical processing, data analysis and interpretation, thematic publications reviewing, manuscript preparation.

Conflict of interest: The authors declare that they do not have any conflict of interests.

N.B. Lebedeva (Corresponding author) — Scientific and Research Institute of Complex Cardiovascular Problems; 6 Sosnovyi Blvd., Kemerovo, Russian Federation 650002. ORCID: https://orcid.org/0000-0003-2769-3807. E-mail: lebenb@mail.ru

L.Yu. Chesnokova — Scientific and Research Institute of Complex Cardiovascular Problems; 6 Sosnovyi Blvd., Kemerovo, Russian Federation 650002. ORCID: https://orcid.org/0000-0002-7471-786Х. E-mail: chesnоkova@mail.ru


Clinical characteristics of patients


Fig. 1. Drug therapy in controls (I) and test (II) group, n (%)


Fig. 2. Dynamics of 6-minute walk test results in experimental groups


Fig. 3. Cognitive test results in experimental groups


Received: 31.03.2020
Accepted: 24.06.20

22 July 17:42
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