Short-term Efficacy Study And Safety Evaluation Of Levosimendanin Non-ischemic Functional Mitral Regurgitation

Objective:Functional mitral regurgitation(FMR)is one of the common complications in patients with cardio myopathy and heart failure.The main clinical manifestations are a series of signs and symptoms of acute congestive heart failure and low cardiac output.According to statistics,FMR is significantly related to the increase of cardio genic death and readmission rate.The treatment of FMR has always been controversial.The guidelines recommend that drug therapy is the cornerstone of FMR treatment,and its efficacy is often limited.It can not effectively delay the progress of the patient’s disease,resulting in a poor prognosis.Studies have found that levosimendan can improve myocardial ischemia and reduce the degree of ischemic FMR,but there are few relevant research data at home and abroad on the effectiveness of FMR caused by non-ischemic changes such as dilated cardio myopathy and heart failure.This study will observe the short-term efficacy and adverse events of levosimendan in patients with non-ischemic FMR without obvious sarrhythmia,to explore the application value of levosimendan in such patients in order to optimize the existing drug treatment regimen,improve the efficacy and improve the prognosis of patients.Methods:Adult FMR patients with normal coronary angiography admitted to the affiliated Hospital of North Sichuan Medical College from January 2017 to December 2021 were selected.MR≥1 with clinical manifestations of heart failure and low cardiac output,no history of seve re heap to renal insufficiency and recent acute myocardial infarction.The patients who met the inclusion exclusion criteria were divided into levo simendan group and GDMT group according to whether they received Levosimendan treatment or not during hospitalization for retrospective analysis.All patients were given drug treatment recommended by the guidelines after admission,and levosimendan group was treated with levosimendan plus levosimendan.Echo cardiographic examination(mitral regurgitation:including regurgitation neck width,regurgitation area/left a trial area,left ventricular structure and function index),laboratory examin ation(NT-proBNP,myocardial injury index,liver and kidney function,elec trolyte,etc.)and cardiac function index(NYHA cardiac function class ification,6-minute walk test,and Borg score)were observed before and after treatment.To evaluate the clinical efficacy and safety of levosimen danon FMR by evaluating the improvement of MR,cardiac function and adverse reactions in the two groups before and after treatment.Results:After balancing the confounding factors by propensity scorematching method,30 pairs of patients were included in the analysis,with 30 patients in each group,All the patients completed the treatment successfully,and there was no significant difference in the general clinical data between the two groups.Most of the patients with non-ischemic FMR were middle-aged and elderly patients with moderate and severe left ventricular dysfunction.The observation index of MR reflux(the width of reflux neck and the area score of reflux)in the observation group and the routine group were lower than those before treatment.The total effective rate of FMR improvement in the observation group was about 73.33%,and there was no deterioration in the degree of FMR in the treatment process.The total effective rate in the routine group was 43.33%,and about 13.33%of the patients had deterioration in the degree of FMR in the treatment process.The improvement of MR in levosimendan group was significantly better than that in routine group.After treatment,LVEF increased significantly in both groups,but there was no significant difference in the improvement of left ventricular function between the two groups.LVEDD and LVESD in the two groups decreased after treatment,and the improvement of left ventricular structure in the levosimendan group was significantly stronger than that in the routine group.After treatment,NYHA cardiac function grade and Borg score were decreased and 6MWT was prolonged in both groups.The improvement of cardiac function and exercise endurance in levosimendan group was better than that in routine treatment group(P<0.05).After treatment,the laboratory indexes CK-MB and hs-CRP of the two groups decreased,and the effect of the observation group on CK-MB was stronger than that of the routine group,and the addition of levosimendan could improve the levels of Cys C and uric acid to a certain extent.The main side effects of the two groups were hypotension and dizziness.After corresponding treatment,the adverse reactions were alleviated and did not affect the treatment.The incidence of adverse reactions in the observation group(6.67%)was lower than that in the routine group(13.33%)(P>0.05).The difference was not statistically significant(P>0.05).Conclusion:Levosimendan can effectively improve the degree of nonischemic functional mitral regurgitation in the short term,and it can significantly improve cardiac function,relieve clinical symptoms,and reduce the levels of inflammatory factors and uric acid.it has a certain protective effect on renal function,ventricular remodeling and myocardial protection are better than conventional drugs,and the incidence of adverse reactions is low.The security is better.