Levosimendanın atrial fibrilasyonlu ve sinüs ritmindeki hastaların sol ventrikül ejeksiyon fraksiyonuna etkisinin karşılaştırılması

Osman Yontar; Mehmet Yılmaz; Gonca Tekin; Hasan Arslantürk; İzzet Tandoğan

EN TR

Comparison of effect of levosimendan on left ventricul ejection fraction of patients with atrial fibrillation and sinus rhythm

Abstract

Aim. Levosimendan (LM) is a unique agent that enhances cardiac contractility. Unlike other
inotropic agents, LM does not increase cellular calcium intake, so that, does not cause intracellular
calcium overload and related arrhythmias. Atrial fibrillation (AF) was shown to be an independent
risk factor for mortality and morbidity in large heart failure (HF) trials. HF induces AF, AF
aggravates HF, and therefore they generally coexist. We conducted a study to investigate the
effects of LM on HF patients with AF. Methods. Sixteen consecutive patients in AF and sixteen
consecutive age-sex matched patients in sinus rhythm who were hospitalized for acutely
decompensated HF, and decided LM administration were enrolled as study (group A) and control
groups (group S). All the patients had echocardiography before and after administration. Results.
Baseline left ventricle ejection fraction (LVEF) was poorer in AF group (mean LVEF for A:
20.4%, S: 27.3%, p:0.03), but when we evaluated LVEF after LM infusion, amount of absolute
increase in both groups’ LVEF values were similar as 7.4 and 6.8 points for group A and S
(p=0.762). Baseline and after infusion mean values of blood pressure and average heart rate were
not significantly different. Conclusions. AF is a debilitating feature of HF; and rate-control
strategies have great importance in AF treatment. LM is effective among patients with HF and AF
just as patients with HF and sinus rhythm.

Keywords

Levosimendanın atrial fibrilasyonlu ve sinüs ritmindeki hastaların sol ventrikül ejeksiyon fraksiyonuna etkisinin karşılaştırılması

Öz

Amaç. Levosimendan (LM) kardiyak kontraktiliteyi arttıran yeni kuşak bir ajandır. Diğer pozitif inotrop ajanların aksine, hücre içi kalsiyum alımını arttırmaz, böylelikle hücre içi kalsiyum aşırı artışı yaratmadığı için ilgili aritmilere de neden olmaz. Atrial fibrilasyonun(AF) kalp yetersizliğinde mortalite ve morbidite için bağımsız bir risk faktörü olduğu büyük randomize çalışmalarda gösterilmiştir. Çalışmamızda, kalp yetersizliği hastalarında, atrial fibrilasyonu olan ve olmayanların LM sonrasında ejeksiyon fraksiyonlarındaki değişimi karşılaştırdık. Yöntem. Sol ventrikül işlev bozukluğuna bağlı akut kalp yetersizliği nedeniyle hastaneye yatırılan on altı ardışık atrial fibrilasyon hastası ile cinsiyet ve yaş uyumu olan sinüs ritmindeki on altı hasta çalışmaya alındı. AF hastaları çalışma grubu (grup A) ve sinüs hastaları kontrol grubuna (grup S) ayrıldı. Hastalara LM verildi, öncesinde ve sonrasında ekokardiyografik inceleme yapıldı. Bulgular. AF, kalp yetersizliğinde prognozu ve kliniği kötüleştiren bir hastalıktır. Akut kalp yetersizliğinde LM kullanımı sinüs ritmindeki hastalara sağlanan fayda ile benzer derecede fayda sağlar. Sonuçlar. AF, kalp yetmezliğinin insan sağlığını bozan bir özelliğidir, ve kalp hızını kontrol etme stratejileri AF tedavisinde büyük öneme sahiptir. LM, HF ve sinüs ritmi olanların yanında HF ve AF olan olgularda etkindir

Anahtar Kelimeler

References

McBride B, White M. Levosimendan: implications for clinicians. J Clin Pharmacol 2003; 43: 1071-81.
Endoh M, The therapeutic potential of novel cardiotonic agents. Expert Opin Investig Drugs 2003;12: 735-50
Moiseyev VS, Poder P, Andrejevs N, Ruda MY, Golikov AP, Lazebnik LB, Kobalava ZD, Lehtonen LA, Laine T, Nieminen MS, Lie KI; RUSSLAN Study Investigators. Safety and efficacy of a novel calcium sensitizer, levosimendan, in patients with left ventricular failure due to an acute myocardial infarction. A randomized, placebo- controlled, double blind study (RUSSLAN). Eur Heart J 2002; 23: 1422-32.
Bellet S. Clinical Disorders of the Heart Beat. 3rd ed. Philadelphia: Lea & Febiger, 1971.
Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, Singer DE. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 2001; 285: 2370-5.
Furberg CD, Psaty BM, Manolio TA, Gardin JM, Smith VE, Rautaharju PM. Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study) Am J Cardiol 1994; 74: 236-41.
Poole-Wilson PA, Swedberg K, Cleland JG, Di Lenarda A, Hanrath P, Komajda M, Lubsen J, Lutiger B, Metra M, Remme WJ, Torp-Pedersen C, Scherhag A, Skene A; Carvedilol Or Metoprolol European Trial Investigators. Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol European Trial (COMET): randomised controlled trial. Lancet 2003; 362: 7- 13.
Maggioni AP, Latini R, Carson PE, Singh SN, Barlera S, Glazer R, Masson S, Cerè E, Tognoni G, Cohn JN; Val-HeFT Investigators. Valsartan reduces the incidence of atrial fibrillation in patients with heart failure: results from the Valsartan Heart Failure Trial (Val-HeFT). Am Heart J 2005; 149: 548-57

Wang TJ, Larson MG, Levy D, Vasan RS, Leip EP, Wolf PA, D'Agostino RB, Murabito JM, Kannel WB, Benjamin EJ. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation 2003; 107: 2920-5.
Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise J, Solomon S, Spencer KT, St John Sutton M, Stewart W; American Society of Echocardiography's Nomenclature and Standards Committee; Task Force on Chamber Quantification; American College of Cardiology Echocardiography Committee; American Heart Association; European Association of Echocardiography, European Society of Cardiology. Recommendations for chamber quantification. Eur J Echocardiogr. 2006 ; 7: 79-108.
Stevenson WG, Stevenson LW. Atrial fibrillation in heart failure. N Engl J Med 1999; 341: 910-1.
Pardaens K, Van Cleemput J, Vanhaecke J, Fagard RH. Atrial fibrillation is associated with a lower exercise capacity in male chronic heart failure patients. Heart 1997; 78: 564- 8.
Hasenfuss G, Holubarsch C, Hermann HP, Astheimer K, Pieske B, Just H. Influence of the force-frequency relationship on haemodynamics and left ventricular function in patients with non-failing hearts and in patients with dilated cardiomyopathy. Eur Heart J 1994; 15: 164-70.
Kass DA. Force-frequency relation in patients with left ventricular hypertrophy and failure. Basic Res Cardiol 1998; 93 (suppl 1): 108-16.
Yu CM, Sanderson JE. Right and left ventricular diastolic function in patients with and without heart failure: effect of age, sex, heart rate, and respiration on Doppler-derived measurements. Am Heart J 1997; 134: 426-34.
Komamura K, Shannon RP, Pasipoularides A, Ihara T, Lader AS, Patrick TA, Bishop SP, Vatner SF. Alterations in left ventricular diastolic function in conscious dogs with pacing induced heart failure. J Clin Invest 1992; 89: 1825-38.
Mebazaa A, Nieminen MS, Packer M, Cohen-Solal A, Kleber FX, Pocock SJ, Thakkar R, Padley RJ, Põder P, Kivikko M; SURVIVE Investigators. Levosimendan vs Dobutamine for Patients With Acute Decompensated Heart Failure The SURVIVE Randomized Trial. JAMA. 2007; 297: 1883-91.

Details

Primary Language

Turkish

Subjects

Health Care Administration

Journal Section

Letter to Editor

Authors

Osman Yontar

Mehmet Yılmaz

Gonca Tekin

Hasan Arslantürk

İzzet Tandoğan

Publication Date

March 22, 2009

Submission Date

March 22, 2009

Acceptance Date

-

Published in Issue

Year 2009 Volume: 31 Number: 3

IZ

https://izlik.org/JA48BF47GE

Cite

RIS / Bibtex

AMA

1.Yontar O, Yılmaz M, Tekin G, Arslantürk H, Tandoğan İ. Levosimendanın atrial fibrilasyonlu ve sinüs ritmindeki hastaların sol ventrikül ejeksiyon fraksiyonuna etkisinin karşılaştırılması. CMJ. 2009;31(3):192-196. https://izlik.org/JA48BF47GE