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Levosimendan in patients with acute cardiogenic shock, not responders to conventional therapy


Cardiogenic shock remains the leading cause of death in patients hospitalized for myocardial infarction, acute valvular disease and after cardiac surgery. Levosimendan (LS) is a new inodilator that has been shown to improve hemodynamic function in patients with decompensated systolic heart failure without increased myocardial oxygen consumption. The aim of this study was to evaluate the use of LS as rescue medication in patients with low ejection fraction (EF) that are not responders to conventional therapy.


Twelve patients with acute cardiogenic shock admitted to the ICU were enrolled. The diagnosis of cardiogenic shock was made on cardiac index (CI) measured by thermodilution catheter <2.5 l/min/m2, and baseline echocardiography with EF measured by the biplan Simpson method <30%. LS (Orion Pharma, Helsinki, Finland) at the dose of 0.1 γ/kg/min for 24 hours continuous infusion was added to standard inotropic agents (dobutamine, enoximone, epinephrine) or IABP when CI and EF seemed not to improve or when the patient's condition worsened. Hemodynamic measurements and echocardiography data were recorded at ICU admission and when pharmacological therapy was changed at 24, 48 and 72 hours.


The data collection showed: an increase in CI (baseline to standard therapy) of 2.6 ± 0.51 (P < 0.001), and standard therapy to LS of 2.93 ± 0.67 (P < 0.003) that seem to be additive. Significant increase in EF was noted in comparison with standard therapy (29.88 ± 6.15, P < 0.035) and after LS therapy (38.44 ± 6.56, P < 0.001) (Figure 1). To find differences between baseline and pharmacological therapy changes at 24, 48 and 72 hours a t test was performed.

Figure 1
figure 1



We found an additive effect of dobutamine, enoximone and LS that theoretically can be explained by the different mechanism of action. Catecholamines increase Ca2+ availability and LS increases myocardial cell calcium sensibility.

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Vetrugno, L., Bassi, F. & Giordano, F. Levosimendan in patients with acute cardiogenic shock, not responders to conventional therapy. Crit Care 11 (Suppl 2), P224 (2007).

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