title: Effect of levosimendan and predictors of recovery in patients with peripartum cardiomyopathy, a randomized clinical trial.
abstract: BACKGROUND
  Levosimendan is a promising new inodilator agent but its effectiveness in peripartum cardiomyopathy (PPCM) has not been tested in a clinical trial. The authors sought to evaluate the effect of levosimendan therapy and to determine the predictors of clinical outcome in patients with PPCM.
  
  
  RESULTS
  The authors prospectively randomized 24 consecutive women with PPCM. Twelve patients (control group) were randomized to conventional heart failure therapy and 12 patients (levosimendan group) were randomized to levosimendan in addition to the conventional therapy. Mean follow-up period was 20.9 ± 9 months (ranged 12-38 months). The two groups did not differ in baseline demographic and echocardiographic characteristics. Eleven patients (45.8%) recovered completely (6 in control group and 5 in levosimendan group, p > 0.05), 6 died (25%) (3 in control group and 3 in levosimendan group), and 7 (29.1%) were left with persistent left ventricular dysfunction (PLVD) (3 in control group and 4 in levosimendan group, p > 0.05). There were significant differences in baseline characteristics between deceased patients and survivors including left ventricular end-diastolic diameter (7.1 ± 0.6 vs. 6.4 ± 0.5 cm, p = 0.031), left ventricular end-systolic diameter (LVESD) (6.4 ± 0.8 vs. 5.5 ± 0.6 cm, p = 0.027), left ventricular ejection fraction (LVEF) (19.7 vs. 27.4%, p = 0.025), and left atrial diameter (4.9 ± 0.3 vs. 4.3 ± 0.4 cm, p = 0.011).
  
  
  CONCLUSIONS
  Addition of levosimendan to conventional therapy did not improve outcome in patients with PPCM. In patients with PLVD or patients who died, LVEF, LVESD and left atrial diameter were worse than those with complete resolution.
authors.affiliation: Department of Cardiology, Haydarpaşa Numune Education and Research Hospital, Bankalar Caddesi, Horoz Apt, 4/5, Cevizli/Kartal, Istanbul, Turkey. murbit2@yahoo.com
authors.forename: Murat
authors.initials: M
authors.lastname: Biteker
authors.forename: Nilüfer Ekşi
authors.initials: NE
authors.lastname: Duran
authors.forename: Hasan
authors.initials: H
authors.lastname: Kaya
authors.forename: Sabahattin
authors.initials: S
authors.lastname: Gündüz
authors.forename: Halil Îbrahim
authors.initials: HÎ
authors.lastname: Tanboğa
authors.forename: Tayyar
authors.initials: T
authors.lastname: Gökdeniz
authors.forename: Gökhan
authors.initials: G
authors.lastname: Kahveci
authors.forename: Taylan
authors.initials: T
authors.lastname: Akgün
authors.forename: Mustafa
authors.initials: M
authors.lastname: Yildiz
authors.forename: Mehmet
authors.initials: M
authors.lastname: Õzkan
mesh_terms: D000328:Adult; D009202:Cardiomyopathies / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D002317:Cardiovascular Agents / Q000494:pharmacology* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000187:drug effects / Q000473:pathology; D006801:Humans; D006835:Hydrazones / Q000494:pharmacology* / Q000627:therapeutic use; D058725:Peripartum Period; D011237:Predictive Value of Tests; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D011724:Pyridazines / Q000494:pharmacology* / Q000627:therapeutic use; D000077464:Simendan; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000494:pharmacology / Q000627:therapeutic use; D016277:Ventricular Function, Left / Q000187:drug effects; D055815:Young Adult
chemical_list: D002317:Cardiovascular Agents; D006835:Hydrazones; D011724:Pyridazines; D014665:Vasodilator Agents; D000077464:Simendan