title: Safety and feasibility of levosimendan administration in takotsubo cardiomyopathy: a case series.
abstract: BACKGROUND
  Levosimendan is a noncatecholamine inotrope that does not increase oxygen consumption, utilized for the treatment for acute heart failure with left ventricular (LV) systolic dysfunction. Its use in takotsubo cardiomyopathy (TTC), a disease that contraindicates the use of catecholamine inotropes, is not well known.
  
  
  METHODS
  We prospectively analyzed 13 consecutive patients with TTC, low ejection fraction (EF) (<35%), and additional Mayo Clinic risk factors who were treated with i.v. infusion of levosimendan. Clinical course of patients, electrocardiogram presentation, LV function, and adverse events at follow-up were recorded.
  
  
  RESULTS
  All patients showed an impaired LV function (LVEF at admission 28 ± 5%), which significantly improved at discharge (51 ± 8%, P < 0.001). Mean hospital stay was 10 ± 4 days. Troponin levels at admission were directly related to length of hospitalization (r = 0.6, P < 0.001). Male gender (relative risk (RR) 1.85, P < 0.05), physical stress (RR 1.90, P < 0.05), ST elevation at ECG (RR 1.87, P < 0.05), and absence of chest pain (RR 2.23, P < 0.01) were found to be the predictors of longer hospital stay. Only 15% of subjects had adverse events during hospital stay; two patients incurred noncardiovascular death at follow-up. Age was the only predictor of adverse event at follow-up (RR 2.13, P < 0.05).
  
  
  CONCLUSIONS
  The use of levosimendan may be safe and feasible in patients with TTC. Randomized studies are warranted to further confirm these preliminary results.
authors.affiliation: Department of Cardiology, University of Foggia, Foggia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Santoro
authors.forename: Riccardo
authors.initials: R
authors.lastname: Ieva
authors.forename: Armando
authors.initials: A
authors.lastname: Ferraretti
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ienco
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Carpagnano
authors.forename: Michele
authors.initials: M
authors.lastname: Lodispoto
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.forename: Matteo
authors.initials: M
authors.lastname: Di Biase
authors.forename: Natale Daniele
authors.initials: ND
authors.lastname: Brunetti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002118:Calcium / Q000378:metabolism; D005260:Female; D006801:Humans; D006835:Hydrazones / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011724:Pyridazines / Q000009:adverse effects*; D000077464:Simendan; D054549:Takotsubo Cardiomyopathy / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan; D002118:Calcium
keywords: Heart failure; Levosimendan; Safety; Takotsubo cardiomyopathy