Levosimendan Produces an Additional Clinical and Hemodynamic Benefit in Patients With Decompensated Heart Failure Successfully Submitted to a Fluid Removal Treatment

Autor: Daniele Landi, Gian F. Gensini, Serafina Valente, Marco Chiostri, Valentina Spini, Emanuele Cecchi, Cristina Giglioli, Salvatore Mario Romano
Rok vydání: 2011
Předmět:
Zdroj: Congestive Heart Failure. 18:47-53
ISSN: 1527-5299
DOI: 10.1111/j.1751-7133.2011.00261.x
Popis: A pivotal role in treating decompensated heart failure (HF) is played by inotropes and calcium sensitizers such as levosimendan. In this study, the authors evaluated whether levosimendan could determine further clinical and hemodynamic benefits in 31 HF patients (New York Heart Association [NYHA] class III or IV), after successful treatment with diuretics (n=15) or ultrafiltration (n=16). Systolic, diastolic, dicrotic, and mean arterial pressures; systemic vascular resistance (SVR); some classic hemodynamic variables (cardiac output [CO], stroke volume [SV], dP ⁄dtmax); and indices of cardiovascular system performance (cardiac cycle efficiency [CCE], cardiac power output) have been assessed by the pressure recording analytical method (PRAM), a minimally invasive monitoring system, before levosimendan infusion, at the end of treatment (EoT), and 36 hours after EoT (post-36). A significant increase in CCE, CO, SV, and dP ⁄dtmax and a significant decrease in diastolic and dicrotic arterial pressures and in SVR have been observed at EoT and at post-36. After the addition of levosimendan, a further reduction in signs and symptoms of HF and NYHA class was observed. Five patients showed an opposite trend of several hemodynamic parameters without any significant clinical improvement (nonresponders). In conclusion, most HF patients treated with diuretics or ultrafiltration receive additional clinical and hemodynamic benefits from levosimendan. The characterization of nonresponders could help in optimizing its use. Congest Heart Fail. 2012;18:47‐53. � 2011 Wiley Periodicals, Inc. Standard therapy for patients with decompensated heart failure (HF) and overhydration is aimed at achieving euvolemia and consists primarily of intravenous diuretics and vasodilators. Patients unresponsive to diuretic therapy or with renal dysfunction can be treated with ultrafiltration and those with hypotension can also be treated with inotropic agents. However, classic inotropic drugs are associated with increased myocardial oxygen consumption, major risk of arrhythmias, and reduced short- and long-term survival. Therefore, attention has been focused on calcium-sensitizing agents, 1,2 a novel class of inotropic drugs, among which levosimendan is the most studied. This group of drugs is able to enhance cardiac performance without increasing intracellular calcium and cyclic adenosine monophosphate levels and, consequently, without the deleterious effects associated with classic inotropic drugs. However, the effective role of levosimendan in the treatment of decompensated congestive HF is yet to be clarified because it is an inotropic agent indicated only when systolic arterial pressure is 90 mm Hg. Therefore, this study was performed to evaluate whether patients with decompensated HF successfully treated with standard therapy, including continuous diuretic infusion or ultrafiltration, receive further clinical and hemodynamic benefits from the addition of levosimendan. Hemodynamic parameters were assessed in the present study with the pressure recording analytical method (PRAM), a minimally invasive monitoring system. 3,4
Databáze: OpenAIRE
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