Levosimendan as rescue therapy in severe cardiogenic shock after ST-elevation myocardial infarction.
Data on the use of levosimendan in patients with myocardial infarction related cardiogenic shock already under combined catecholamine treatment and intra-aortic balloon counterpulsation (IABP) are scarce. Seven consecutive patients with refractory cardiogenic shock after ST-elevation myocardial infarction, multi-organ dysfunction syndrome and under maximal intensive care (combined catecholamine treatment, IABP) were treated with levosimendan (bolus 12 microg/kg i.v., thereafter 0.1 microg/kg over 24 h). Hemodynamic effects were registered invasively and monitored over 72h post infusion. Therapy with levosimendan significantly reduced required epinephrine dose after 48h (P=0.02 versus baseline). Norepinephrine dose had to be increased during the first 12 h of levosimendan (+25%; P=ns), but was significantly reduced at 72 h compared to baseline (median 0.14 versus 0.06 microg/kg/min after 72 h; P<0.05). Cardiac power output increased (baseline 0.6 versus 1.1 > or = 48 h after infusion; P<0.01) and systemic vascular resistance decreased (median 1294 dyn*s*cm-5 at baseline versus 858 dyn*s*cm-5 at 24 h; P<0.05) after levosimendan infusion. IABP therapy could be weaned in all patients during 5 days after infusion and all patients survived the cardiogenic shock (ICU mortality 29%). Levosimendan as an adjunctive, rescue therapy in patients with severe cardiogenic shock may be safe with beneficial effects on hemodynamics over 72 h.
Greif
Martin
M
Medizinische Klinik und Poliklinik I, University Medical Center Munich-Grosshadern, Ludwig-Maximilians University of Munich, Munich, Germany.
Zwermann
Ludwig
L
Reithmann
Christopher
C
Weis
Michael
M
D000368:Aged; D002302:Cardiac Output; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use*; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D009638:Norepinephrine / Q000008:administration & dosage; D011446:Prospective Studies; D011724:Pyridazines / Q000627:therapeutic use*; D012770:Shock, Cardiogenic / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D000077464:Simendan; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D018487:Ventricular Dysfunction, Left / Q000209:etiology
D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D014662:Vasoconstrictor Agents; D000077464:Simendan; D009638:Norepinephrine