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  • Meeting abstract
  • Open Access

Levosimendan improves hemodynamic effects in patients with acutely decompensated heart failure: the Argentinean multicenter registry

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  • 1,
  • 1,
  • 1,
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  • 1 and
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Critical Care20037 (Suppl 3) :P19

https://doi.org/10.1186/cc2215

  • Published:

Keywords

  • Catheter
  • Ejection Fraction
  • Continuous Infusion
  • Cardiac Index
  • Myocarditis

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.

Authors’ Affiliations

(1)
Transplant/Heart Failure Division, Favaloro Foundation, Buenos Aires, 1746, Belgrano, 1093, Argentina

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