Levosimendan: A retrospective single-center case series

TY - JOUR

T1 - Levosimendan

T2 - A retrospective single-center case series

AU - Berry, Will

AU - Hewson, Russell W.

AU - Langrish, Chris J.

AU - Mckenzie, Catherine A.

AU - Barrett, Nicholas

PY - 2013/12

Y1 - 2013/12

N2 - Purpose: The purpose of this study is to describe the effect of levosimendan (without loading dose) on hemodynamics, inotropes/vasopressors, and mortality in acute heart failure (AHF).Materials and Methods: Patients who received levosimendan for AHF were analyzed. Levosimendan dose, hemodynamic data, inotrope/vasopressor requirements, and fluid balance before commencement, at conclusion of, and 24 hours after levosimendan were collected. Mortality is also reported.Results: Eighty-seven patients were analyzed. The mean levosimendan dose (without loading) was 0.096 mu g/kg per minute (+/- 0.014), and mean duration, 26 (+/- 7.2) hours. There was no change in heart rate (start, post, and 24 hours post) (92 [+/- 19], 92 [+/- 26], and 92 [+/- 15]) or mean arterial pressure (69 [+/- 10], 72 [+/- 8], and 72 [+/- 10] mm Hg, respectively). There was a significant reduction in median dobutamine from 7.27 to 0 mu g/kg per minute and noradrenaline from 0.20 to 0.1 mu g/kg per minute before and 24 hours after. There was a significant increase in both mean cardiac index from 2.38 +/- 0.0.72 to 2.98 +/- 0.0.77 L/min per square meter and in markers of perfusion: base excess from - 2.77 to 0.39 mmol/L, and lactate from 2.1 to 1.4 mmol/L before and 24 hours after infusion. Survival was 53%.Conclusions: Levosimendan, without a loading dose, improved cardiac index and perfusion while allowing a reduction in inotropic/vasopressor requirements in patients with AHF.

AB - Purpose: The purpose of this study is to describe the effect of levosimendan (without loading dose) on hemodynamics, inotropes/vasopressors, and mortality in acute heart failure (AHF).Materials and Methods: Patients who received levosimendan for AHF were analyzed. Levosimendan dose, hemodynamic data, inotrope/vasopressor requirements, and fluid balance before commencement, at conclusion of, and 24 hours after levosimendan were collected. Mortality is also reported.Results: Eighty-seven patients were analyzed. The mean levosimendan dose (without loading) was 0.096 mu g/kg per minute (+/- 0.014), and mean duration, 26 (+/- 7.2) hours. There was no change in heart rate (start, post, and 24 hours post) (92 [+/- 19], 92 [+/- 26], and 92 [+/- 15]) or mean arterial pressure (69 [+/- 10], 72 [+/- 8], and 72 [+/- 10] mm Hg, respectively). There was a significant reduction in median dobutamine from 7.27 to 0 mu g/kg per minute and noradrenaline from 0.20 to 0.1 mu g/kg per minute before and 24 hours after. There was a significant increase in both mean cardiac index from 2.38 +/- 0.0.72 to 2.98 +/- 0.0.77 L/min per square meter and in markers of perfusion: base excess from - 2.77 to 0.39 mmol/L, and lactate from 2.1 to 1.4 mmol/L before and 24 hours after infusion. Survival was 53%.Conclusions: Levosimendan, without a loading dose, improved cardiac index and perfusion while allowing a reduction in inotropic/vasopressor requirements in patients with AHF.

KW - Levosimendan

KW - Acute heart failure

KW - Cardiogenic shock

KW - Dobutamine

KW - Noradrenaline

KW - DECOMPENSATED HEART-FAILURE

KW - ACUTE MYOCARDIAL-INFARCTION

KW - CARDIOGENIC-SHOCK

KW - CALCIUM SENSITIZER

KW - RANDOMIZED-TRIAL

KW - DOBUTAMINE

KW - HEMODYNAMICS

KW - METAANALYSIS

KW - ANGIOPLASTY

KW - GUIDELINES

U2 - 10.1016/j.jcrc.2013.06.014

DO - 10.1016/j.jcrc.2013.06.014

M3 - Article

SN - 0883-9441

VL - 28

SP - 1075

EP - 1078

JO - Journal of Critical Care

JF - Journal of Critical Care

IS - 6

ER -