Abstract:

Objective

To evaluate the efficacy of levosimendan in the treatment of pulmonary hypertension (PH) combined with right heart failure.

Methods

PubMed， Embase，Web of Science， Cochrane Library， Wanfang， VIP and CNKI databases were searched for studies on the efficacy of levosimendan in the treatment of patients with right heart failure and PH published up to November 30， 2022.The Jüni scale was used to evaluate the quality of the included literature.The Review Manager 5.4 software was used for data analysis.

Results

A total of 10 studies were included， containing 681 patients with PH and right heart failure.The meta-analysis showed that after levosimendan treatment， their mean pulmonary artery pressure［standard mean difference (SMD)= -1.35， 95% confidence internal (CI) (-2.55， -0.15)， Z = 2.20，P=0.03］， systolic pulmonary artery pressure ［SMD=-0.82， 95%CI (-1.09， -0.55)， Z=5.93， P ＜0.000 01］ and N-terminal pro-brain natriuretic peptide ［SMD = -0.80， 95%CI (-1.17， -0.42)， Z =4.12， P ＜0.000 1］ were significantly decreased， while their tricuspid annular plane systolic excursion［SMD=0.49， 95%CI (0.29， 0.68)， Z=4.88， P ＜0.000 01］， mixed venous oxygen saturation ［SMD=0.60， 95%CI (0.32， 0.89)， Z = 4.12， P ＜0.000 1］ and 6-minute walking distance ［SMD = 0.62，95%CI (0.40， 0.84)， Z=5.52， P ＜0.000 01］ were significantly increased.

Conclusion

Levosimendan can significantly reduce pulmonary artery pressure， improve right ventricular function and increase exercise tolerance in patients with PH and right heart failure.

Key words: Levosimendan, Pulmonary hypertension, Right heart failure, Meta-analysis