A PEER-REVIEWED JOURNAL OF RESEARCH AND CLINICAL MEDICINEISSN 1727-2378 (Print)         ISSN 2713-2994 (Online)
Ru
En

Levosimendan Efficacy in Patients with Myocardial Infarction and Chronic Cerebral Ischemia

DOI:10.31550/1727-2378-2020-19-5-19-23
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

Доктор.ру

Table
Clinical characteristics of patients

t3_1.jpg

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

r3_1.jpg

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

r3_2.jpg

Fig. 3. Cognitive test results in experimental groups

r3_3.jpg

Received: 31.03.2020
Accepted: 24.06.20

22 July 17:42
REFERENCES
  1. Boytsov S.A., Shal'nova S.A., Deev A.D. Mortality from cardiovascular diseases in the Russian Federation and possible mechanisms for its change. S.S. Korsakov Journal of Neurology and Psychiatry. 2018; 118(8): 98–103. (in Russian). DOI: 10.17116/jnevro201811808198
  2. Lam C.S.P., Gamble G.D., Ling L.H. Sim D. Mortality associated with heart failure with preserved vs. reduced ejection fraction in a prospective international multi-ethnic cohort study. Eur. Heart J. 2018; 39(20): 1770–80. DOI: 10.1093/eurheartj/ehy005
  3. Lozhkina N.G., Glebchenko E.A., Khasanova M.Kh., Kozik V.A., Kuimov A.D. Risk factors of the lethal outcome in patients with acute coronary syndrome on stationary stage. Modern problems of science and education. 2016; 6. (in Russian). URL: http://science-education.ru/ru/article/view?id=26026 (Access date: 15.05.2020).
  4. Mikhaylova Z.D., Shalenkova M.A., Shubin L.B., Klimkin P.F. Predictors for complicated course of non-ST elevation coronary syndrome during in-hospital period. Heart. 2016; 2(88): 104–10. (in Russian). DOI: 10.18087/rhj.2016.2.2172
  5. Mezhonov E.M., Vyalkina Yu.A., Vakulchik K.A., Shalaev S.V. Predictors of acute heart failure in patients with ST-segment elevation myocardial infarction of the electrocardiogram after PCI. Cardiology. 2018; 58(S8): 20–8. (in Russian). DOI:10.18087/cardio.2493
  6. Hou L., Gao C., Feng J., Chen Z.-F., Zhang J., JiangY.-J. et al. Prognostic factors for in-hospital and long-term survival in patients with acute ST-segment elevation myocardial infarction after percutaneous coronary intervention. Tohoku J. Exp. Med. 2017; 242(1): 27–35. DOI: 10.1620/tjem.242.27
  7. Mareev V.Yu., Fomin I.V., Ageev F.T., Arutjunov G.P., Bagrambekova Yu.L., Belenkov Yu.N. et al. Clinical recommendations. Chronic heart failure. Heart Failure. 2017; 1: 3–40. (in Russian). DOI: 10.18087/ rhfj.2017.1.2346
  8. Nieminen M.S., Buerke M., Cohen-Solál A., Costa S., Édes I., Erlikh A. et al. Role of levosimendan in the treatment of acute heart failure complicating the acute coronary syndrome: review and consensus of experts. Int. J. Cardiol. 2016; 218: 150–7. DOI: 10.1016/j.ijcard.2016.05.009
  9. Maack C., Eschenhagen T., Hamdani N. Treatments targeting inotropy. Eur. Heart J. 2019; 40(44): 3626–44. DOI:10.1093/eurheartj/ehy600
  10. Kivikko M., Pollesllo P., Tarvasmäki T., Sarapohja T., Nieminen M.S., Harjola V.-P. Effect of baseline characteristics on mortality in the SURVIVE trial on the effect of levosimendan vs dobutamine in acute heart failure: sub-analysis of the Finnish patients. Int. J. Сardiol. 2016; 215: 26–31. DOI: 10.1016/j.ijcard.2016.04.064
  11. Pollesello P., Papp Z. The cardioprotective effects of levosimendan: preclinical and clinical evidence. J. Cardiovasc. Pharmacol. 2007; 50(3): 257–63. DOI: 10.1097/FJC.0b013e3180986230
  12. Sonntag S., Sundberg S., Lehtonen L.A., Kleber F.X. The calcium sensitizer levosimendan improves the function of stunned myocardium after percutaneous transluminal coronary angioplasty in acute myocardial ischemia. J. Am. Coll. Cardiol. 2004; 43(12): 2177–82. DOI: 10.1016/j.jacc.2004.02.052
  13. Slawsky M.T., Colucci W.S., Gottlieb S.S., Greenberg B.H., Haeusslein E., Hare J. et al. Acute hemodynamic and clinical effects of levosimendan in patients with severe heart failure. Circulation. 2000; 102(18): 2222–7. DOI: 10.1161/01.cir.102.18.2222
  14. Eremenko A.A., Rybka M.M. Anti-ischemic and cardioprotective effects of levosimendan. Annals of Critical Care. 2016; 4: 27–33. (in Russian)
  15. Lomivorotov V.V., Boboshko V.A. Pleiotropic effects of levosimendan on the heart and other organs. Circulation Pathology and Cardiac Surgery. 2017; 21(2): 14–28. (in Russian). DOI: 10.21688/1681-3472-2017-2-14-28
  16. Roehl A.B., Zoremba N., Kipp M., Schiefer J., Goetzenich A., Bleilevens C. et al. The effects of levosimendan on brain metabolism during initial recovery from global transient ischaemia/hypoxia. BMC Neurol. 2012; 12: 81. DOI: 10.1186/1471-2377-12-81
  17. Isakov L.K., Sinkova M.N., Lebedeva N.B., Tarasov N.I., Vatutin M.K., Mesyats L.A. An elderly patient withcomplicated myocardial infarction: focus on inotropic stimulation and cytoprotection. Bulletin of Contemporary Clinical Medicine. 2016; 9(6): 47–51. (in Russian). DOI: 10.20969/VSKM.2016.9(6).47-51

Похожие статьи

News

1 October 10:52
A New Issue of Doctor.Ru Internal Medicine, Vol. 21, No. 6 (2022), Published

Find original articles and reviews covering various aspects of сardiology, gastroenterology, internal medicine and the interview with Professor Alexey Nikolaevich Kalyagin

7 July 17:16
A New Issue of Doctor.Ru Neurology Psychiatry, Vol. 21, No. 4 (2022), Published

Find original articles and reviews covering various aspects of neurology, psychiatry and the interview with Professor Alexander Vitalievich Amelin

12 May 11:25
A New Issue of Doctor.Ru Pediatrics, Vol. 21 No. 3 (2022), Published

See the original papers, reviews and clinical cases in headings Pulmonology, Rheumatology, Endocrinology, Neurology, Cross-disciplinary approach and Interview with with an Honoured Scientist of the Sakha (Yakutia) Republic Professor Maria Vasilievna Khandy

4 May 10:02
A New Issue of Doctor.Ru Internal Medicine, Vol. 21, No. 2 (2022), Published

Find original articles and reviews covering various aspects of gastroenterology, internal medicine, rheumatology, endocrinology, special section of postgraduate training and the interview with Professor Dmitry Alexeevich Sychev

18 March 00:00
A New Issue of Doctor.Ru Gynecology, Vol. 21 No. 1 (2022), Published

Find original articles and reviews covering various aspects of obstetrics, perinatology and gynecology, and the interview with Feldberg Dov, MD

All news