Akutní srdeční selhání pod dojmem studií REVIvE a SURVIVE

Interv Akut Kardiol. 2006;5(1):40-41

ACUTE HEART FAILURE IN LIGHT OF THE REVIVE AND SURVIVE STUDIES

Tomáš Brychta: Interní kardiologická klinika FN a LF MU v Brně

Since it affects approximately 1 million people in the US every year, acute heart failure (AHF) and its treatment pose a significant medical challenge. At an American Heart Association congress in November 2005, the REVIVE and SURVIVE studies were presented which evaluated the treatment of AHF with levosimendan. The REVIVE study evaluated the effect of levosimendan versus placebo in fully treated patients. The study included 700 patients. The following parameters were assessed: the course of the B-type natriuretic peptide (BNP) levels, the general condition of the patient during the first 6 hours, dyspnoea during the first 6 hours, the length of hospitalization after administration, death or heart failure deterioration at 31 days, NYHA classification at 5 days after administration, and overall mortality at 90 days. The results showed more improved and fewer worsened patients following levosimendan administration who required full treatment of heart failure, dyspnoea or pulmonary oedema. There was a significant decrease in BNP on days 1 and 5 following administration as well as a significant reduction in the length of hospitalization for AHF. SURVIVE was a mortality study which included 1327 patients and compared the effect of levosimendan versus dobutamine. The primary endpoint was 180-day all-cause mortality, the secondary endpoints included 31-day all-cause mortality, changes in BNP, necessity of hospitalization at 180 days after administration, dyspnoea during the first 24 hours, the general condition of the patient during the first 24 hours, and 180-day cardiovascular mortality. The primary goal was 26.1% vs 27.9% (p=0.91) in favour of the patients treated with levosimendan, the secondary endpoint outcomes favoured the treatment with levosimendan, particularly the statistically significant (p=0.0001) decrease in BNP on days 1, 3 and 5 following administration.