Effect of Levosimendan on Diastolic Function in Patients Undergoing Coronary Artery Bypass Grafting: A Comparative Study.
OBJECTIVE
To compare the efficacy of levosimendan with nitroglycerin in patients with isolated diastolic dysfunction undergoing coronary artery bypass grafting.


METHODS
Thirty patients with isolated diastolic dysfunction undergoing on-pump coronary artery bypass grafting were randomized into 2 groups receiving levosimendan or nitroglycerin infusion. The infusion was started before sternotomy and continued in the postoperative period. Perioperatively, diastolic function was serially evaluated at 3 different time points using echocardiography. N-terminal fragment of pro-B-natriuretic peptide (NT-proBNP) levels were measured in both the groups.


RESULTS
There was a significant improvement in diastolic function as measured by isovolumic relaxation time (P = 0.0001, P = 0.001) and deceleration time (P = 0.0001, P = 0.0001) in the levosimendan group from the baseline in patients with impaired relaxation. Similarly, tissue Doppler imaging also revealed an improvement from the baseline in patients with a pseudonormal pattern (P = 0.018, P = 0.001). Furthermore, there was a significant improvement in the above parameters when compared with the nitroglycerin group. The NT-proBNP levels also demonstrated a similar pattern between the 2 groups (P = 0.03, P = 0.02) when levosimendan was compared with nitroglycerin in patients with a pseudonormal pattern on echocardiography.


CONCLUSIONS
Levosimendan is superior to nitroglycerin in improving diastolic function irrespective of coronary revascularization.
Departments of *Cardiac Anesthesiology; and †Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India.
Vishwas
V
Malik
Arun
A
Subramanian
Milind
M
Hote
Usha
U
Kiran
D000368:Aged; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D003971:Diastole; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006835:Hydrazones / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D011724:Pyridazines / Q000494:pharmacology / Q000627:therapeutic use*; D000077464:Simendan; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000494:pharmacology / Q000627:therapeutic use*
D006835:Hydrazones; D011724:Pyridazines; D014665:Vasodilator Agents; D000077464:Simendan