Hemodynamic improvement following levosimendan treatment in patients with acute myocardial infarction and cardiogenic shock.
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.
Russ
Martin A
MA
Department of Internal Medicine III, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany.
Prondzinsky
Roland
R
Christoph
Arnd
A
Schlitt
Axel
A
Buerke
Ute
U
Söffker
Gerold
G
Lemm
Henning
H
Swyter
Michael
M
Wegener
Nikolas
N
Winkler
Matthias
M
Carter
Justin M
JM
Reith
Sebastian
S
Werdan
Karl
K
Buerke
Michael
M
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
D002316:Cardiotonic Agents; D002395:Catecholamines; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan; D004280:Dobutamine