title: Single-centred experience with levosimendan in paediatric decompensated dilated cardiomyopathy.
abstract: BACKGROUND
  Children with dilated cardiomyopathy in advanced heart failure may spend a long time awaiting heart transplantation. Consequently, mechanical circulatory support is sometimes required as a bridge to transplantation. Levosimendan, a positive inotropic agent, has been reported to be safe and efficient for the treatment of paediatric heart failure.
  
  
  OBJECTIVE
  To report our experience with levosimendan in children with decompensated dilated cardiomyopathy.
  
  
  METHODS
  Paediatric patients with dilated cardiomyopathy on the transplant waiting list and with criteria for mechanical support were included in this single-centred retrospective study. Each patient received at least one 24-hour infusion of levosimendan before mechanical circulatory support was considered. Biological and echocardiographic data were analysed.
  
  
  RESULTS
  Six patients were included over a 24-month period. The median age was 25.5months (7.7-34.2months); 82 infusions were performed. Median B-type natriuretic peptide concentration decreased significantly between days 0 and 2 (2443ng/L [1458-3819ng/L] vs 1358ng/L [1025-2534ng/L]; P=0.003). While only a trend was noted in left ventricular ejection fraction improvement (P=0.054 by Simpson's method and P=0.068 by the Teicholz method), the subaortic velocity time integral rose significantly between days 0 and 8 (12.8cm/s [10-14.5cm/s] vs 15.3cm/s [14.3-16.9cm/s]; P=0.041).
  
  
  CONCLUSIONS
  Levosimendan seems to improve haemodynamics in children with decompensated dilated cardiomyopathy; repeated infusions may delay the need for mechanical circulatory support while awaiting heart transplantation. This therapeutic agent should be systematically considered in this setting, in addition to conventional inotropic drugs.
authors: Paediatric Cardiology Unit, Bordeaux University Hospital, Bordeaux, France. Electronic address: peseguela@yahoo.fr.
authors: Pierre-Emmanuel
authors: PE
authors: Séguéla
authors: Department of Paediatric Cardiac Anaesthesiology, Bordeaux University Hospital, Bordeaux, France.
authors: Philippe
authors: P
authors: Mauriat
authors: Paediatric Cardiology Unit, Bordeaux University Hospital, Bordeaux, France.
authors: Jean-Baptiste
authors: JB
authors: Mouton
authors: Department of Paediatric Cardiac Anaesthesiology, Bordeaux University Hospital, Bordeaux, France.
authors: Nadir
authors: N
authors: Tafer
authors: Department of Paediatric Cardiac Anaesthesiology, Bordeaux University Hospital, Bordeaux, France.
authors: Jana
authors: J
authors: Assy
authors: Paediatric Cardiology Unit, Bordeaux University Hospital, Bordeaux, France.
authors: Géraldine
authors: G
authors: Poncelet
authors: Department of Paediatric Cardiac Anaesthesiology, Bordeaux University Hospital, Bordeaux, France.
authors: Karine
authors: K
authors: Nubret
authors: Paediatric Cardiology Unit, Bordeaux University Hospital, Bordeaux, France.
authors: Xavier
authors: X
authors: Iriart
authors: Paediatric Cardiology Unit, Bordeaux University Hospital, Bordeaux, France.
authors: Jean-Benoit
authors: JB
authors: Thambo
mesh_terms: D000293:Adolescent; D015415:Biomarkers; D002232:Carbocyanines; D002311:Cardiomyopathy, Dilated / Q000150:complications*; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D004341:Drug Evaluation; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D009557:Nipecotic Acids / Q000097:blood; D010879:Piperazines / Q000097:blood; D011724:Pyridazines / Q000627:therapeutic use*; D012189:Retrospective Studies; D000077464:Simendan; D013318:Stroke Volume; D016896:Treatment Outcome; D014463:Ultrasonography; D014850:Waiting Lists
chemical_list: C091791:3,3'-dipropylthiacarbocyanine; D015415:Biomarkers; D002232:Carbocyanines; D002316:Cardiotonic Agents; D006835:Hydrazones; D009557:Nipecotic Acids; D010879:Piperazines; D011724:Pyridazines; D000077464:Simendan; C063976:N,N'-bis(1-decylnipecotoyl)piperazine; D003404:Creatinine
keywords: Brain natriuretic peptide; Brain natriurétique peptide; Cardiomyopathie dilatée; Dilated cardiomyopathy; Insuffisance cardiaque pédiatrique; Levosimendan; Paediatric heart failure; Paediatric heart transplantation; Transplantation cardiaque pédiatrique