부산대학교 도서관

Aim. To evaluate the efficacy of action of the calcium sensitizer levosimendan (LS) in patients with various grade of heart failure (HF) severity before cardiosurgery.Material and methods. LS was applied as a part of HF treatment while preparing patients for surgery in 2-4 days. Performed dose was 0,025 — 0,1 µg/kg/min. The drug was not administered in bolus. Preoperation group of participants included 108 patients (62% — men, 38% — women, aged 20 — 72 years (53±13)) with CHF III-IV FC by NYHA, with ejection fraction of the left ventricle (LVEF) about in average 27±8%.Mean level of natriuretic B-type peptide was 1129 (Me 854, Q25 396, Q75 1419) pg/mL. Main etiology of chronic HF in participants was dilation cardiomyopathy: noncoronary cardiomyopathy in 30 patients (27,7%), ischemic cardiomyopathy (ischemic heart disease, postinfarction cardiosclerosis) in 72 patients (66,7%) and acquired valve defects in 6 patients (5,6%). For assessment of efficacy of the drug in various grade of HF severity, patients were selected to subgroups according to the level of LVEF decrease (less 20%, 21-30%, 31-40%, more 40%), and pulmonary artery pressure (PAWP) (less 40 mmHg, 40-70 mmHg, more 70 mmHg).Results. Infusion of the drug led to statistically significant increase of LVEF comparing to the baseline (57%), decrease of PAWP (64%) and BNP concentration in 77% cases. Conclusion. The LS is an effective medication which can be applied with the aims to prepare HF patients to cardiosurgical operations. Most sensitive parameters of LS efficacy are PAWP, LVEF and BNP concentration. The highest efficacy of the drug was observed in subgroup with EF ≤40%, PAWP ≥40 mmHg and BNP ≥600 pg/mL. LS, applied in HF patients before cardiosurgery, can be used for assessment of reserves of myocardial capacity.