Prolongirani hemodinamski učinak, sigurnost primjene i kardioprotektivni učinak levosimendana na funkciju miokarda tijekom i nakon aortokoronarnog premoštenja bez primjene izvantjelesnog krvotoka [Prolonged hemodynamic effect, safety and cardioprotective effect of levosimendan on myocardial function during and after off-pump coronary artery bypass grafting]

Barišin, Stjepan (2007) Prolongirani hemodinamski učinak, sigurnost primjene i kardioprotektivni učinak levosimendana na funkciju miokarda tijekom i nakon aortokoronarnog premoštenja bez primjene izvantjelesnog krvotoka [Prolonged hemodynamic effect, safety and cardioprotective effect of levosimendan on myocardial function during and after off-pump coronary artery bypass grafting]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Patients undergoing OPCABG were randomized to the groups receiving a bolus dose of 12 mikrog/kg (Levo-L, n=11) or 24 mg/kg (Levo-H, n=10) levosimendan, and placebo group (Pl, n=10). Acute and prolonged hemodynamic effect was assessed immediately upon, and 5, 20 and 50 min of drug infusion, and 48 h of OPCABG. Monitoring by the method of thermodilution and transesophageal echocardiography showed the inotropic response manifested as CO and LVEF to be more pronounced in the Levo-L (p=0.001 and p=0.002) and Levo-H (p<0.001 and p=0.006) groups. In levosimendan groups, prolonged inotropic response was less pronounced than acute response. The cardioprotective effect of levosimendan was evaluated by measuring the values of CK, CK-MB and troponin I. At 24 h of OPCABG, a significant troponin I decrease was recorded in Levo-L group as compared with Pl group (0.4 mikrog/L vs 2.4 mg/L; p=0.033). Relative to the higher dosage, levosimendan in a dose of 12 mikrog/kg showed a favorable inotropic and cardioprotective effect, and is recommended as an alternative therapeutic option in patients with preserved systolic LV function undergoing OPCABG.

Abstract in Croatian

Bolesnici podvrgnuti OPCABG operacijskom zahvatu metodom slučajnih brojeva randomizirani su u tri skupine: bolesnici koji su primili bolus dozu 12 mikrog/kg (Levo-L, n = 11) ili 24 mikrog/kg levosimendana (Levo-H, n = 10), te bolesnici placebo skupine (Pl, n = 10). Akutni i prolongirani hemodinamski učinak izmjeren je odmah nakon završetka infuzije, 5 minuta, 20 minuta, 50 minuta nakon infuzije lijeka, te 48 sati nakon završetka aortokoronarnog premoštenja. Praćen metodom bolus termodilucije i transezofagusnom ehokardiografijom, snažniji inotropni odgovor izražen kao CO i LVEF zabilježen je u Levo-L (p = 0,001 i p = 0,002) i Levo-H skupini (p < 0,001 i p = 0,006). Prolongirani inotropni odgovor u levosimendanskim skupinama bio je slabiji u odnosu na akutni odgovor. Za procjenu kardioprotektivnog učinka levosimendana mjerene su serumske vrijednosti CK, CK-MB i troponina I. Značajni pad troponina I u Levo-L (0,4 mikrog/L) u odnosu na Pl skupinu (2,4 mikrog/L) zabilježen je 24 sata nakon završetka aortokoronarnog premoštenja (p = 0,033). Levosimendan u dozi od 12 mikrog/kg, u odnosu na višu dozu, pokazao je povoljan inotropni i kardioprotektivni učinak, te se preporučuje kao alternativna terapijska opcija u bolesnika podvrgnutih OPCABG operacijskom zahvatu s očuvanom sistoličkom funkcijom LV.

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