| Abstract | 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. |
| Abstract (english) | 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. |
