title: Levosimendan: a retrospective single-center case series.
abstract: OBJECTIVE
  The purpose of this study is to describe the effect of levosimendan (without loading dose) on hemodynamics, inotropes/vasopressors, and mortality in acute heart failure (AHF).
  
  
  METHODS
  Patients who received levosimendan for AHF were analyzed. Levosimendan dose, hemodynamic data, inotrope/vasopressor requirements, and fluid balance before commencement, at conclusion of, and 24 hours after levosimendan were collected. Mortality is also reported.
  
  
  RESULTS
  Eighty-seven patients were analyzed. The mean levosimendan dose (without loading) was 0.096 μg/kg per minute (±0.014), and mean duration, 26 (±7.2) hours. There was no change in heart rate (start, post, and 24 hours post) (92 [±19], 92 [±26], and 92 [±15]) or mean arterial pressure (69 [±10], 72 [±8], and 72 [±10] mm Hg, respectively). There was a significant reduction in median dobutamine from 7.27 to 0 μg/kg per minute and noradrenaline from 0.20 to 0.1 μg/kg per minute before and 24 hours after. There was a significant increase in both mean cardiac index from 2.38 ± 0.0.72 to 2.98 ± 0.0.77 L/min per square meter and in markers of perfusion: base excess from -2.77 to 0.39 mmol/L, and lactate from 2.1 to 1.4 mmol/L before and 24 hours after infusion. Survival was 53%.
  
  
  CONCLUSIONS
  Levosimendan, without a loading dose, improved cardiac index and perfusion while allowing a reduction in inotropic/vasopressor requirements in patients with AHF.
authors.affiliation: Institute of Pharmaceutical Sciences, Kings College London, London SE1 9RT, United Kingdom; Pharmacy and Critical Care, Guy's and St. Thomas' Foundation Hospital, London SE1 7EH, United Kingdom.
authors.forename: William T
authors.initials: WT
authors.lastname: Berry
authors.forename: Russell W
authors.initials: RW
authors.lastname: Hewson
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Langrish
authors.forename: Catherine A
authors.initials: CA
authors.lastname: McKenzie
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Barrett
mesh_terms: D000368:Aged; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004280:Dobutamine / Q000008:administration & dosage; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality*; D006439:Hemodynamics / Q000187:drug effects; D017052:Hospital Mortality; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage / Q000627:therapeutic use*; D007362:Intensive Care Units; D008297:Male; D020105:Milrinone / Q000008:administration & dosage; D009638:Norepinephrine / Q000008:administration & dosage; D011724:Pyridazines / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D000077464:Simendan; D013566:Sympathomimetics / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D013566:Sympathomimetics; D000077464:Simendan; D004280:Dobutamine; D020105:Milrinone; D009638:Norepinephrine
keywords: ACC; AHA; AHF; Acute heart failure; American college of cardiology; American heart association; Cardiogenic shock; Dobutamine; ESC; European society of cardiology; GSTT; Guys and St.Thomas’ NHS Foundation Trust; IBM; International business machines; Levosimendan; Noradrenaline