Hemodynamic and echographic effects of levosimendan in patients with cardiogenic shock refractory to catecholamines
© BioMed Central Ltd 2006
Published: 21 March 2006
Levosimendan is a novel inodilator that has proved effective in treating advanced congestive heart failure but has been poorly evaluated in cardiogenic shock.
To characterize the hemodynamic and echographic effects of levosimendan in patients with cardiogenic shock refractory to catecholamines.
Nine patients (53.3 ± 19 years, five male/four female) with persisting cardiogenic shock following acute myocardial infarction (five cases), peripartum cardiomyopathy (two cases) or dilated cardiomyopathy (two cases) were candidates for levosimendan infusion. In all patients, a high dose of inotropic treatment failed to improve hemodynamic parameters. Levosimendan was introduced at a loading dose of 12 μg/kg followed by a continuous infusion of 0.1 μg/kg/min for 24 hours. Hemodynamic measurements were performed using a Swan–Ganz thermodilution catheter (744HF75; Edwards Life Sciences, Carolina, USA) at baseline and at 30 and 90 min, 6, 12, 24 and 48 hours after the start of levosimendan. Transoesophageal echocardiography was performed at baseline, 12 and 24 hours and then after 7 and 15 days in survivors.
Levosimendan induced a significant decline of pulmonary capillary wedge pressure and systemic vascular resistances, followed by a significant increase in the cardiac index and mixed venous oxygen saturation. Changes in the heart rate and mean arterial blood pressure were not significant. The left ventricular ejection fraction was improved from 24% to 40% within 48 hours.