Open AccessEfficacy and safety of a calcium sensitizer, levosimendan, in patients with right heart failure due to pulmonary hypertension
Author(s) -
Jiang Rong,
Zhao QinHua,
Wu WenHui,
Zhang Rui,
Yuan Ping,
Gong SuGang,
He Jing,
Luo CiJun,
Qiu HongLing,
Wang Lan,
Liu JinMing
Publication year - 2018
Publication title -
the clinical respiratory journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.789
H-Index - 33
eISSN - 1752-699X
pISSN - 1752-6981
DOI - 10.1111/crj.12699
Subject(s) - levosimendan , medicine , pulmonary hypertension , cardiology , heart failure , calcium , right heart failure , intensive care medicine
Background Despite using vasoactive and pulmonary hypertension (PH) specific therapies, the in‐hospital mortality of severe PH with right heart failure (RHF) is high. We conducted a prospective analysis evaluating the efficacy and safety of levosimendan in PH patients with severe acute RHF. Methods Forty‐five PH patients hospitalized between January 2016 and November 2016 were recruited into a single arm, prospective, open‐label study. Levosimendan was administered at the rate of .05–0.1 μg/kg/min, up to a total dose of 12.5 mg. The primary endpoints were changes of World Health Organization Function Class (WHO‐FC) and Borg dyspnoea scores. Secondary endpoints included changes in 6‐min walk distance (6‐MWD), biochemical markers and right heart structure and function together with adverse events on day 7 and incidence of major cardiovascular events (death or readmission due to RHF) on day 30. Results Forty‐five PH patients were enrolled. On the 7th day after levosimendan infusion, seven out of 13 PH patients with WHO‐FC IV improved by one class ( P = .008). Borg dyspnoea scores, 6‐MWD and NT‐proBNP improved significantly ( P < .001). Compared with baseline, the right atrial transverse dimension, end‐systolic eccentricity index and tricuspid annular plane systolic excursion improved significantly (58.8 ± 13.1 mm vs 53.7 ± 12.4 mm; 1.50 ± 0.27 vs 1.38 ± 0.23; 15.0 (13.0, 16.0) mm vs 15.8 (14.0, 17.4) mm, P < .005, respectively). One patient occurred sudden death after discharge during follow‐up. Conclusions Intravenous levosimendan can effectively improve severe RHF of PH patients in hospital and well tolerated.