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

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

doi:10.3389/fmed.2022.778620

Abstract

AimsAcute 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).MethodsThis 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.ResultsOxygen 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.ConclusionsLevosimendan 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.

Highlights

Pulmonary arterial hypertension (PAH) has been extensively identified as a disease condition that affects small pulmonary arteries by causing progressive vascular narrowing, resulting in increased pulmonary arterial resistance and eventual right ventricular failure [1]
This study examined the effect of levosimendan on acute decompensated right heart failure (RHF) in patients with connective tissue disease-associated pulmonary arterial hypertension (CTD-PAH)
Oxygen saturation of mixed venose blood (SvO2), estimated glomerular filtration rate, 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

Summary

Introduction

Pulmonary arterial hypertension (PAH) has been extensively identified as a disease condition that affects small pulmonary arteries by causing progressive vascular narrowing, resulting in increased pulmonary arterial resistance and eventual right ventricular failure [1]. Acute decompensated RHF is distinguished by a rapid exacerbation of the pathological signs of RHF followed by congestion and systemic circulatory inefficiency, which could result in multisystem organ failure [3, 4]. Therapeutic interventions for patients with connective tissue disease-associated pulmonary arterial hypertension (CTD-PAH) are usually more complicated than those for idiopathic PAH. In individuals with PAH linked to systemic lupus erythematosus or mixed CTD in the chronic phase, immunosuppressive treatment that combines cyclophosphamide and glucocorticoids might yield positive clinical outcomes [8], which could result in a therapeutic process similar to idiopathic PAH [9]. The benefit from traditional medical therapies is somewhat lacking, stressing the importance of alternative therapeutic strategies in patients who are unable to undergo timely urgent lung transplantation and right ventricle assistance devices

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Conclusion