Effect of Levosimendan on Acute Decompensated Right Heart Failure in Patients With Connective Tissue Disease-Associated Pulmonary Arterial Hypertension

Chao Qu; Wei Feng; Qi Zhao; Qi Liu; Xing Luo; Gang Wang; Meng Sun; Zhibo Yao; Yufei Sun; Shenglong Hou; Chunyang Zhao; Ruoxi Zhang; Xiufen Qu

doi:10.3389/fmed.2022.778620

Effect of Levosimendan on Acute Decompensated Right Heart Failure in Patients With Connective Tissue Disease-Associated Pulmonary Arterial Hypertension

Front Med (Lausanne). 2022 Mar 4:9:778620. doi: 10.3389/fmed.2022.778620. eCollection 2022.

Authors

Chao Qu¹, Wei Feng², Qi Zhao², Qi Liu³, Xing Luo^{3

4}, Gang Wang^{3

4}, Meng Sun⁴, Zhibo Yao^{3

4}, Yufei Sun^{3

4}, Shenglong Hou¹, Chunyang Zhao⁵, Ruoxi Zhang⁶, Xiufen Qu²

Affiliations

¹ Department of Cardiology, Heilongjiang Provincial People's Hospital, Harbin, China.
² Department of Cardiology, 1st Affiliated Hospital of Harbin Medical University, Harbin, China.
³ Department of Cardiology, 2nd Affiliated Hospital of Harbin Medical University, Harbin, China.
⁴ The Key Laboratory of Myocardial Ischemia, Ministry of Education, Harbin Medical University, Harbin, China.
⁵ Department of Cardiology, Harbin 242 Hospital, Harbin, China.
⁶ Department of Cardiology, Harbin Yinghua Hospital, Harbin, China.

Abstract

Aims: Acute decompensated right heart failure (RHF) in chronic precapillary pulmonary hypertension is often typified by a swiftly progressive syndrome involving systemic congestion. This results from the impairment of the right ventricular filling and/or a reduction in the flow output of the right ventricle, which has been linked to a dismal prognosis of short duration. Despite this, there are limited therapeutic data regarding these acute incidents. This study examined the effect of levosimendan on acute decompensated RHF in patients with connective tissue disease-associated pulmonary arterial hypertension (CTD-PAH).

Methods: This retrospective study included 87 patients with confirmed CTD-PAH complicated acute decompensated RHF between November 2015 and April 2021. We collected biological, clinical, and demographic data, as well as therapy data, from patients with acute decompensated RHF who required levosimendan treatment in the cardiac care unit (CCU) for CTD-PAH. The patients were divided into two groups according to the levosimendan treatment. Patient information between the two groups was systematically compared in hospital and at follow-up.

Results: Oxygen saturation of mixed venose blood (SvO₂), estimated glomerular filtration rate (eGFR), 24-h urine output, and tricuspid annular plane systolic excursion (TAPSE) were found to be considerably elevated in the levosimendan cohort compared with the control cohort. Patients in the levosimendan cohort exhibited considerably reduced levels of C-reactive protein (CRP), white blood cell (WBC), troponin I, creatinine, NT-proBNP, and RV diameter compared with those in the control cohort. A higher survival rate was observed in the levosimendan cohort.

Conclusions: Levosimendan treatment could effectively improve acute decompensated RHF and systemic hemodynamics in CTD-PAH patients, with positive effects on survival in hospital and can, therefore, be considered as an alternative treatment option for improving clinical short-term outcomes.

Keywords: connective tissue disease; decompensation; levosimendan; pulmonary arterial hypertension; right heart failure.