Background
Levosimendan (Ls) is a novel inotropic agent, calcium sensitizer and vasodilator indicated for the treatment of patients (patients) with acutely decompensated heart failure (ADHF). Randomized trials show Ls to be an effective and safe option for the management of ADHF.
Objective
To analyze the hemodynamic effects of intravenous Ls in patients with ADHF.
Method
Data from 10 Argentinean hospitals in a multicenter registry were collected. Eligibility criteria were clinical ADHF, ejection fraction ≤ 40%, cardiac index ≤ 2.5 l/min/m2, and pulmonary capillary pressure ≥ 15 mmHg if a Swan–Ganz (SG) catheter was used. We analyzed the data of the 41 patients monitored with a SG catheter. Complete clinical, radiographic, EKG, and laboratory examinations were performed before and after Ls. Ls was administered as a loading dose of 6–24 μg/kg over 10 min, followed by a continuous infusion of 0.1–0.2 μg/kg/min for 24 hours. Hemodynamic measures were recorded at baseline, 30 min, 2, 6, 24, and 48 hours. Data were compared using the t test or Wilcoxon rank-sum test.
Results
Basal characteristics (mean ± standard deviation [range]) included age 61.4 ± 10.95 years (21–81 years), male 75.6%, and left ventricular ejection fraction 19.5 ± 6.95% (10–39%; n = 32). Etiologies were: ischemic, 48.8%; idiopathic, 22%; valvular, 9.3%; chagasic, 7.3%; myocarditis, 4.9%; restrictive, 2.4%; other, 4.9%. Hemodynamic measures at baseline and 48 hours after Ls are included in Table 1; similar results were obtained at 24 hours.
Table 1.
| Measure | Baseline (mean ± standard deviation) | 48 hours (mean ± standard deviation) | P value |
|---|---|---|---|
| Pulmonary capillary pressure (mmHg) | 24.1 ± 6.0 | 17.0 ± 5.3 | 0.0001 |
| Pulmonary vascular resistance (dyne s cm-5) | 280 ± 182 | 188 ± 110 | 0.008 |
| Systemic vascular resistance (dyne s cm-5) | 1690 ± 558 | 1066 ± 295 | < 0.0001 |
| Mean arterial pressure (mmHg) | 77.0 ± 11 | 71.0 ± 10.8 | 0.001 |
| Right atrial pressure (mmHg) | 9.3 ± 5.7 | 6.5 ± 3.8 | < 0.008 |
| Cardiac index (l/min/m2) | 1.88 ± 0.44 | 2.77 ± 0.5 | < 0.0001 |
| Cardiac output (l/min) | 3.49 ± 0.9 | 5.01 ± 1.1 | 0.0001 |
| Heart rate (beats/min) | 84 ± 14 | 87 ± 15 | 0.2 |
Conclusion
Ls significantly improved pulmonary pressures, cardiac index and output, with no significant effects on heart rate in patients with ADHF. Ls is an effective and safe option that should be considered for the management of ADHF.