title: Hemodynamic improvement following levosimendan treatment in patients with acute myocardial infarction and cardiogenic shock.
abstract: OBJECTIVE
  Levosimendan, a novel inodilator, has been shown to improve hemodynamic function in patients with acute exacerbation of congestive heart failure. We wanted to determine the hemodynamic effects of levosimendan following ineffective conventional therapy (with catecholamines) in patients with cardiogenic shock following myocardial infarction.
  
  
  METHODS
  Observational hemodynamic study.
  
  
  METHODS
  Tertiary care center university hospital.
  
  
  METHODS
  Fifty-six patients with cardiogenic shock secondary to myocardial infarction were treated with percutaneous revascularization (intra-aortic balloon pump where appropriate) and commenced on conventional inotropic therapy.
  
  
  METHODS
  Patients with persisting cardiogenic shock 24 hrs after revascularization were additionally treated with levosimendan (rapid bolus of 12 microg/kg for 10 mins, then 0.05-0.2 mug/kg/min for 24 hrs) (n = 25).
  
  
  RESULTS
  With conventional catecholamine therapy (norepinephrine and dobutamine), we observed only marginal improvement in mean arterial pressure or cardiac index. In contrast, the addition of levosimendan produced a significant increase in cardiac index (2.1 +/- 0.56 to 3.0 +/- 1.11 L/min/m2, p < .01) and cardiac power index (0.32 +/- 0.08 to 0.44 +/- 0.18 W, p < .01), whereas systemic vascular resistance decreased significantly (1208 +/- 333 to 858 +/- 299 dyne.sec.cm(-5), p < .01). There was no significant change in blood pressure during levosimendan treatment. Hemodynamic improvement was sustained after levosimendan infusion was stopped.
  
  
  CONCLUSIONS
  Levosimendan infusion in cardiogenic shock following acute myocardial infarction improved cardiovascular hemodynamics without leading to hypotension.
authors: Department of Internal Medicine III, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany.
authors: Martin A
authors: MA
authors: Russ
authors: Roland
authors: R
authors: Prondzinsky
authors: Arnd
authors: A
authors: Christoph
authors: Axel
authors: A
authors: Schlitt
authors: Ute
authors: U
authors: Buerke
authors: Gerold
authors: G
authors: Söffker
authors: Henning
authors: H
authors: Lemm
authors: Michael
authors: M
authors: Swyter
authors: Nikolas
authors: N
authors: Wegener
authors: Matthias
authors: M
authors: Winkler
authors: Justin M
authors: JM
authors: Carter
authors: Sebastian
authors: S
authors: Reith
authors: Karl
authors: K
authors: Werdan
authors: Michael
authors: M
authors: Buerke
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D002316:Cardiotonic Agents / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D002395:Catecholamines / Q000494:pharmacology / Q000627:therapeutic use; D004280:Dobutamine / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006835:Hydrazones / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011724:Pyridazines / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D012770:Shock, Cardiogenic / Q000188:drug therapy* / Q000628:therapy; D000077464:Simendan
chemical_list: D002316:Cardiotonic Agents; D002395:Catecholamines; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan; D004280:Dobutamine