title: Levosimendan restores both systolic and diastolic cardiac performance in lipopolysaccharide-treated rabbits: comparison with dobutamine and milrinone.
abstract: OBJECTIVE
  Current treatment strategies for severe septic conditions (i.e., intravenous fluids, vasopressors, and cardiac inotropes) reestablish fluid balance and improve cardiac systole but do not address diastolic dysfunction. Our study aimed to fully characterize both systolic and diastolic abnormalities of sepsis-associated heart failure and to identify treatment that would support full-cycle cardiac improvement.
  
  
  METHODS
  Endotoxin-injected rabbits, an animal model of abnormal cardiac function in human sepsis, were used to delineate cardiac abnormalities and to examine effects of drug treatments on heart systolic and diastolic function (n = 30); saline-injected animals served as comparators (n = 17). As treatment, three inotropes commonly used for treatment of cardiac failure were infused for 45 mins in separate animal groups-milrinone, dobutamine, and levosimendan.
  
  
  METHODS
  Variables of left ventricular systolic and diastolic function were assessed with a pressure conductance catheter. Measurements were made before and after endotoxin/saline injection and before and after inotrope treatment.
  
  
  RESULTS
  Pressure-volume analyses of the left ventricle showed marked impairment in systolic function and in all indices of diastolic function (isovolumic relaxation time constant, left ventricular end-diastolic pressure, and end-diastolic pressure-volume relationship) in endotoxin-treated rabbits. The inotropes, milrinone, dobutamine, and levosimendan, could each partially or completely restore systolic function in the lipopolysaccharide-treated rabbits. However, only levosimendan therapy led to additional beneficial effects on left ventricular relaxation and diastolic function.
  
  
  CONCLUSIONS
  Cardiac failure in severe sepsis results from impairments in both systolic and diastolic functions. Treatment with the calcium sensitizer levosimendan improved both systolic and diastolic cardiac functions in septic animals, but cyclic adenosine monophosphate-dependent inotropes milrinone and dobutamine only improved systolic function.
authors.affiliation: Equipe d'Accueil 322, Université, Paris, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Barraud
authors.forename: Valérie
authors.initials: V
authors.lastname: Faivre
authors.forename: Thibault
authors.initials: T
authors.lastname: Damy
authors.forename: Stéphane
authors.initials: S
authors.lastname: Welschbillig
authors.forename: Etienne
authors.initials: E
authors.lastname: Gayat
authors.forename: Christophe
authors.initials: C
authors.lastname: Heymes
authors.forename: Didier
authors.initials: D
authors.lastname: Payen
authors.forename: Ajay M
authors.initials: AM
authors.lastname: Shah
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
mesh_terms: D000818:Animals; D002316:Cardiotonic Agents / Q000494:pharmacology* / Q000627:therapeutic use; D003971:Diastole / Q000187:drug effects*; D004195:Disease Models, Animal; D004280:Dobutamine / Q000494:pharmacology / Q000627:therapeutic use; D006333:Heart Failure / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D006835:Hydrazones / Q000494:pharmacology* / Q000627:therapeutic use; D008070:Lipopolysaccharides; D020105:Milrinone / Q000494:pharmacology / Q000627:therapeutic use; D011724:Pyridazines / Q000494:pharmacology* / Q000627:therapeutic use; D011817:Rabbits; D018805:Sepsis / Q000150:complications*; D000077464:Simendan; D013599:Systole / Q000187:drug effects*; D016277:Ventricular Function, Left / Q000187:drug effects*
chemical_list: D002316:Cardiotonic Agents; D006835:Hydrazones; D008070:Lipopolysaccharides; D011724:Pyridazines; D000077464:Simendan; D004280:Dobutamine; D020105:Milrinone