Guokai Shang1, Xinyan Yang1, Daijun Song2, Yun Ti1, Yuanyuan Shang1, Zhihao Wang1,3, Mengxiong Tang1,4, Yun Zhang1, Wei Zhang1, Ming Zhong5. 1. The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, #107 West Wenhua Road, Ji'nan, 250012, People's Republic of China. 2. Department of Emergency, Donggang People's Hospital, Rizhao, 276800, People's Republic of China. 3. Department of Geriatrics, Qilu Hospital of Shandong University, Ji'nan, 250012, People's Republic of China. 4. Department of Emergency, Qilu Hospital of Shandong University, Ji'nan, 250012, People's Republic of China. 5. The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, #107 West Wenhua Road, Ji'nan, 250012, People's Republic of China. zhongmingzm@gmail.com.
Abstract
BACKGROUND: The prognosis for patients with heart failure (HF), including cardiogenic shock (CS), complicating acute coronary syndrome (ACS) remains poor. OBJECTIVE: This study aimed to review the relevant literature and evaluate whether levosimendan was associated with better clinical outcomes in these patients. METHODS: We searched PubMed, EMBASE, and the Cochrane library databases for randomized controlled trials that investigated levosimendan compared with any control in patients with HF/CS complicating ACS. RESULTS: A total of 1065 patients from nine trials were included in this study. Analysis showed that levosimendan significantly reduced total mortality and the incidence of worsening HF. In patients with HF-ACS, levosimendan was associated with reduced mortality. In patients with CS-ACS, no significant difference was observed between the two groups. Levosimendan contributed to significantly reduced mortality when compared with placebo, but no significant reduction was seen compared with dobutamine. Compared with controls, levosimendan decreased pulmonary capillary wedge pressure and systemic vascular resistance and increased cardiac index, with no significant difference observed between the groups in terms of heart rate. Levosimendan non-significantly increased the risk of hypotension but did not increase the risk of ischemic episodes, sinus tachycardia, atrial fibrillation, or ventricular arrhythmias. CONCLUSION: Levosimendan appears to be a promising drug to reduce mortality and worsening HF in patients with HF/CS-ACS. It appears to provide hemodynamic benefit and was associated with an increased risk of hypotension.
BACKGROUND: The prognosis for patients with heart failure (HF), including cardiogenic shock (CS), complicating acute coronary syndrome (ACS) remains poor. OBJECTIVE: This study aimed to review the relevant literature and evaluate whether levosimendan was associated with better clinical outcomes in these patients. METHODS: We searched PubMed, EMBASE, and the Cochrane library databases for randomized controlled trials that investigated levosimendan compared with any control in patients with HF/CS complicating ACS. RESULTS: A total of 1065 patients from nine trials were included in this study. Analysis showed that levosimendan significantly reduced total mortality and the incidence of worsening HF. In patients with HF-ACS, levosimendan was associated with reduced mortality. In patients with CS-ACS, no significant difference was observed between the two groups. Levosimendan contributed to significantly reduced mortality when compared with placebo, but no significant reduction was seen compared with dobutamine. Compared with controls, levosimendan decreased pulmonary capillary wedge pressure and systemic vascular resistance and increased cardiac index, with no significant difference observed between the groups in terms of heart rate. Levosimendan non-significantly increased the risk of hypotension but did not increase the risk of ischemic episodes, sinus tachycardia, atrial fibrillation, or ventricular arrhythmias. CONCLUSION:Levosimendan appears to be a promising drug to reduce mortality and worsening HF in patients with HF/CS-ACS. It appears to provide hemodynamic benefit and was associated with an increased risk of hypotension.
Authors: Olga N Kislitsina; Jonathan D Rich; Jane E Wilcox; Duc T Pham; Andrei Churyla; Esther B Vorovich; Kambiz Ghafourian; Clyde W Yancy Journal: Curr Cardiol Rev Date: 2019
Authors: Piergiuseppe Agostoni; Dimitrios T Farmakis; Jose M García-Pinilla; Veli-Pekka Harjola; Kristjan Karason; Dirk von Lewinski; John Parissis; Piero Pollesello; Gerhard Pölzl; Alejandro Recio-Mayoral; Alexander Reinecke; Patrik Yerly; Endre Zima Journal: Card Fail Rev Date: 2019-11-04