Effects of levosimendan in acute heart failure, cardiogenic and septic shock

Introduction

Levosimendan, a calcium sensitizer, improves cardiac output in patients with acute decompensated heart failure (ADHF). Its effect in patients with cardiogenic and septic shock remains unknown. We hypothesized that levosimendan improves cardiac output similarly in patients with ADHF (group A), cardiogenic (group C), and septic shock (group S).

Methods

Sixty consecutive patients were enrolled in this prospective observational study. Levosimendan infusion was started in all patients at 0.05 μg/kg/min intravenously, without a bolus dose, and was increased by 0.05 μg/kg/min every 30 minutes to a maximum of 0.2 μg/kg/min intravenously, at which time levosimendan infusion was continued for 24 hours. The thermodilution cardiac output and central venous saturation (ScvO₂) were measured at baseline and every 4 hours thereafter for a total of 48 hours. Hypotension (mean arterial pressure < 65 mmHg) was treated with norepinephrine, titrated to mean arterial pressure ≥ 65 mmHg.

Results

APACHE II scores were 15 ± 7, 18 ± 7, and 22 ± 7 (P = 0.01) and median (IQR) ICU length of stay was 5 (3.9), 8 (6.23), and 11 (7.21) days (P < 0.01) for groups A, C, and S, respectively. During the first 48 hours, the cardiac index increased within each group (P = 0.01) but there were no differences in cardiac index between the study groups (P = 0.58), and the ScvO₂ did not change significantly within and between study groups (Figure 1). Group S received more norepinephrine than did the other groups (P < 0.05).

Figure 1

Changes in central venous saturation (ScvO₂).

Conclusion

Levosimendan has similar hemodynamic effects when administered to patients with ADHF, cardiogenic, and septic shock. It did not appear to have a significant effect on ScvO₂.