İbrahim IZGU, Gulten TACOY, Guliz Erdem YAZICI, Yusuf TAVİL, Timur TIMURKAYNAK, Deniz DEMIRKAN

Akut Dekompanze Kalp Yetmezliği varlığında Levosimendan Tedavisi esnasında NT-pro BNP düzeyi ve Sol Ventrikül Ejeksiyon Fraksiyonunun Prognostik Etkisinin Değerlendirilmesi

Amaç: Akut dekompanze kalp yetmezliği nedeniyle levosimendan tedavisi alan hastalarda serum NT-pro BNP düzeyleri ve sol ventrikül ejeksiyon fraksiyonunun prognostik öneminin araştırılması. Yöntem: NYHA sınıflamasına göre sınıf IV fonksiyonel kapasiteye sahip, intavenöz ve vazodilatör tedaviye cevap vermeyen ve düşük kardiyak debi bulgularına sahip 14 kalp yetmezliği hastası ( 10 erkek (%71.4), 4 kadın (%28.6) çalışmaya dahil edildi. Klinik durum, hemodinamik parametreler olarak sistolik (SBP) ve diastolik kan basıncı (DBP) değerleri, serum NT-pro BNP, BUN, kreatinin, Na+, K+, AST, ALT, Hb, Htc düzeyleri, ekokardiyografik olarak sol ventrikül diastol (LVEDD) ve sistol sonu çapları (LVESD) hacimleri, kardiyak debi ve ejeksiyon fraksiyonu (LVEF) parametreleri levosimendan tedavisi öncesi ve sonrasında elde edilerek karşılaştırıldı. Bulgular: Dekompanze kalp yetmezliği varlığında, levosimendan tedavisi sol ventrikül diastol sonu çapı ve hacmi, sol ventrikül sistol sonu hacmi, diastolik kan basıncı, serum NT-pro BNP düzeylerinde belirgin azalmaya ve sol ventrikül ejeksiyon fraksiyonunda artmaya neden olmuştur (p< 0.05). NT-pro BNP düzeyi ile sol ventrikül EF arasında anlamlı ters ilişki varlığı ortaya konmuştur (p

Anahtar Kelimeler:

Kalp yetmezliği, levosimendan, NT-pro BNP, ejeksiyon fraksiyonu

The Evaluation of The Prognostic Effect of NT-Pro BNP Levels and Left Ventricular Ejection Fraction in Acute Decompansated Heart Failure During Levosimendan Treatment

Aim: To evaluate the prognostic effect of serum NT-proBNP levels and left ventricular ejection fraction in patients who have acute decompansated heart failure and receive levosimendan treatment. Method: Fourteen patients (10 male (71,4 %), 4 female (28,6%)) with heart failure who have low cardiac output findings and unresponsive to intravenous and vasodilator therapy, functional capacity NHYA class IV were enrolled into the study. Clinical status, systolic (SBP) and diastolic blood (DBP) pressures as hemodynamic parameters, measurements of serum NT-proBNP, BUN, Cre, Na+, K+, AST, ALT, Hb, Htc levels; left ventricular end diastolic (LVEDD) and systolic (LVESD) diameters, end diastolic (LVEDV) and end systolic (LVESV) volumes, cardiac output and ejection fraction (LVEF) by echocardiographic evaluation were obtained before and after levosimendan infusion Results: Treatment with levosimendan in decompansated heart failure exerts significantly reduction in LVEDD, LVEDV, LVESV, DBP, serum NT-proBNP levels and increase in LVEF (p

Keywords:

Heart failure, levosimendan, NT-proBNP, LVEF,

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Kopustinskiene DM, Pollesello P, Saris N: EL Levosimendan is a mitochondrial KATP channel opener. Eur J Pharmacol 428 (3): 311-4, 2001.

Follath F, Cleland JGF, Just H, et al. Efficacy and safety of intravenous levosimendan compared with dobutamine in severe low-output heart failure (the LIDO study): a randomised double-blind trial. Lancet. 360 (9328): 196-202

Gardner RS, Özapl F, Murday AJ et al. N- terminal pro-brain natriuretic peptide. A new gold standard in predicting mortality in patients with advanced heart failure. Eur Heart J :1735-1743, 2003.

Greenberg B, Borghi C, Perrone S: Pharmacotherapeutic approaches for decompensated heart failure: a role for the calcium sentitiser, levosimendan? Eur J Heart Fail. 5(1):13-21, 2003.

Troughton RW, Frampton CM, Yandle TG, Espiner EA, Nicholls MG, Richards AM: Treatment of heart failure guided by plasma NTproBNP concentrations. Lancet (9210):1126-30, 2000.

Mebazaa A: The SURVIVE-W Trial: Comparison of Dobutamine and Levosimendan on Survival in Acute Decompensated Heart Failure. American Heart Association Scientific Sessions; Dallas, 2005.

Packer M. REVIVE II: Multicenter Placebo- Controlled Trial of Levosimendan on Clinical Status in Acutely Decompensated Heart Failure. American Heart Association Scientific Sessions; Dallas, 2005.

Avgeropoulou C, Andreadou I, Markantonis-Kyroudis S, Demopoulou M, Missovoulos P, Androulakis A, Kallikazaros I: The Ca+2 sensitizer Levosimendan improves oxidative damage, BNP and pro-inflammatory cytokine levels in patients with advanced decompensated heart failure in comparison to dobutamine. Eur J Heart Fail. 7(5):882- , 2005. de Lemos JA, McGuire DK, Drazner

MH: B-type natriuretic peptide in cardiovascular disease. Lancet. (9380):316–22, 2003.

McLean AS, Huang SJ, Tang B and Nalos M: Levosimendan benefits critically ill patients with decompensated heart failure assessed with plasma B-type natriuretic peptide (BNP) and LVEF. Critical Care. 7 (Suppl 2):P056, 2003.

Innes CA, Wagstaff AJ: Levosimendan. A review of its use in the management of acute decompensated heart failure. Drugs. 63(23): 2651-2671, 2003.

Moiseyev VS, Poder P, Andrejevs N, et al. 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. 23 (18): 1422- , 2002.