title: Levosimendan improves hemodynamic status in critically ill patients with severe aortic stenosis and left ventricular dysfunction: an interventional study.
abstract: OBJECTIVE
  To study the hemodynamic effect of levosimendan administration in acute heart failure patients with severe aortic stenosis (AS) and reduced left ventricular ejection fraction (LVEF).
  
  
  METHODS
  Hemodynamic response to 24 h intravenous levosimendan infusion (0.1 μg/kg/min without a loading dose) in patients with severe AS (aortic valve area ≤1 cm(2) , time-velocity integral between left ventricular out-flow tract and aortic valve <0.25), reduced LVEF (≤40%), and a depressed cardiac index (CI) <2.2 L/min/m(2) was determined in a sequential group of nine patients aged 76 ± 10 years (5 men).
  
  
  RESULTS
  Baseline mean ejection fraction was 33 ± 0.7%; mean aortic valve area was 0.37 ±0.11 cm(2) /m(2) ; peak and mean gradients of 63.6 ± 20.53 and 36.7 ± 12.62 mmHg, respectively; and mean CI was 1.65 ± 0.20 L/min/m(2) . At 6 and 12 h of levosimendan therapy, mean CI had increased to 2.00 ± 0.41 L/min/m(2) (P = 0.02) and 2.17 ± 0.40 L/min/m(2) (P = 0.01), respectively. At 24 h, mean CI had increased further to 2.37 ± 0.49 L/min/m(2) (P = 0.01). A significant beneficial effect was also observed in pulmonary capillary wedge pressure, pulmonary artery mean pressure, central venous pressure, systemic vascular resistances, pulmonary vascular resistances, stroke volume index, left ventricular stroke work index. NTproBNP levels decreased at 24 h of levosimendan treatment. Levosimendan infusion was also well tolerated. Five patients subsequently underwent aortic valve surgery replacement. One died (of postoperative multiorgan failure). At 30 days, overall survival was 75%.
  
  
  CONCLUSIONS
  Levosimendan administration improves hemodynamic parameters in critically ill patients with severe AS and reduced LVEF. In our study, it provides a safe and effective bridge to aortic-valve replacement or oral vasodilator therapy in surgical contraindicated patients. A controlled study is needed to confirm these preliminary findings.
authors.affiliation: Acute Cardiac Care Unit, Department of Cardiology, Hospital Universitario de Canarias - Servicio Canario de la Salud, Tenerife, Spain.
authors.forename: Martín J
authors.initials: MJ
authors.lastname: García-González
authors.affiliation: Acute Cardiac Care Unit, Department of Cardiology, Hospital Universitario de Canarias - Servicio Canario de la Salud, Tenerife, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Jorge-Pérez
authors.affiliation: Research Unit, Hospital Universitario de Canarias, Ctra. La Cuesta - Taco, San Cristobal de La Laguna, Sta. Cruz de Tenerife, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Jiménez-Sosa
authors.affiliation: Acute Cardiac Care Unit, Department of Cardiology, Hospital Universitario de Canarias - Servicio Canario de la Salud, Tenerife, Spain.
authors.forename: Antonio Barragán
authors.initials: AB
authors.lastname: Acea
authors.affiliation: Acute Cardiac Care Unit, Department of Cardiology, Hospital Universitario de Canarias - Servicio Canario de la Salud, Tenerife, Spain.
authors.forename: Juan B
authors.initials: JB
authors.lastname: Lacalzada Almeida
authors.affiliation: Acute Cardiac Care Unit, Department of Cardiology, Hospital Universitario de Canarias - Servicio Canario de la Salud, Tenerife, Spain.
authors.forename: Julio J
authors.initials: JJ
authors.lastname: Ferrer Hita
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D002317:Cardiovascular Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016638:Critical Illness; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011724:Pyridazines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D020127:Recovery of Function; D012720:Severity of Illness Index; D000077464:Simendan; D013030:Spain; D013318:Stroke Volume / Q000187:drug effects; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016277:Ventricular Function, Left / Q000187:drug effects*
chemical_list: D002317:Cardiovascular Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan
keywords: Acute heart failure; Aortic stenosis; Critical cardiac care; Left ventricular dysfunction; Levosimendan