- Poster presentation
- Open Access
Levosimendan in patients with acute cardiogenic shock, not responders to conventional therapy
© BioMed Central Ltd. 2007
- Published: 22 March 2007
- Ejection Fraction
- Cardiac Index
- Cardiogenic Shock
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.
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.