title: Decongestive effects of levosimendan in cardiogenic shock induced by postpartum cardiomyopathy.
abstract: BACKGROUND
  Catecholamines and/or levosimendan have been proposed for haemodynamic restoration during cardiogenic shock (CS). In CS induced by post-partum cardiomyopathy (PPCM), levosimendan might be particularly favourable. The aim of this study was to evaluate the haemodynamic and echocardiographic effects of levosimendan in patients with CS, in particular in patients with PPCM-induced CS.
  
  
  METHODS
  Twenty-eight patients with refractory CS were retrospectively included in the study. Among them, a cohort of 8 women with PPCM-induced CS was included. All patients were treated with levosimendan (loading dose followed by a continuous infusion for 24 h) and were invasively monitored, including a pulmonary artery catheter, for 48hours. Echocardiographic measurements were performed at baseline and during follow-up.
  
  
  RESULTS
  Significant improvements in haemodynamic parameters were observed 48 h after starting levosimendan. The cardiac index increased (+1.2±0.6L/min, P<0.001) and filling pressures decreased (pulmonary artery occlusion pressure, PAOP: -11.2±4.3mmHg, P<0.001; right-atrial pressure, RAP: -6.1±4.9mmHg, P<0.001). The left ventricular ejection fraction was significantly higher at 48 h compared to baseline (38% [34-46%] versus 27% [22-30%], P<0.001). Despite similar characteristics at baseline, in the subgroup of patients with PPCM, more profound decongestive effects at 48hours were observed: PAOP (13±2 versus 17±4mmHg, P=0.007) and RAP (12±4 versus 17±4mmHg, P=0.006) were significantly lower in the PPCM subgroup compared to the non-PPCM subgroup.
  
  
  CONCLUSIONS
  Haemodynamics and left-ventricular ejection fraction rapidly improved after treatment with levosimendan. In patients with PPCM-induced CS, a more profound reduction of congestion was observed.
authors.affiliation: University of Tunis El Manar, department of anaesthesiology and critical care medicine, military hospital of Tunis, Tunis, Tunisia. Electronic address: iheb1labbene@yahoo.fr.
authors.forename: I
authors.initials: I
authors.lastname: Labbene
authors.affiliation: Inserm UMR-S 942, Paris, France. Electronic address: mattia.arrigo@usz.ch.
authors.forename: M
authors.initials: M
authors.lastname: Arrigo
authors.affiliation: Serviço de cuidados intensivos, departamento de anestesia cuidados intensivos e emergência, hospital de Santo António, centro hospitalar do Porto, Porto, Portugal. Electronic address: m.j.s.tavares@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Tavares
authors.affiliation: University of Tunis El Manar, department of anaesthesiology and critical care medicine, military hospital of Tunis, Tunis, Tunisia. Electronic address: hajjej_zied@hotmail.com.
authors.forename: Z
authors.initials: Z
authors.lastname: Hajjej
authors.affiliation: Serviço de cuidados intensivos, departamento de anestesia cuidados intensivos e emergência, hospital de Santo António, centro hospitalar do Porto, Porto, Portugal. Electronic address: jlpintobrandao@gmail.com.
authors.forename: J L
authors.initials: JL
authors.lastname: Brandão
authors.affiliation: Inserm UMR-S 942, Paris, France. Electronic address: heli.tolppanen@helsinki.fi.
authors.forename: H
authors.initials: H
authors.lastname: Tolppanen
authors.affiliation: Inserm UMR-S 942, Paris, France. Electronic address: elodie.feliot.lrb@gmail.com.
authors.forename: E
authors.initials: E
authors.lastname: Feliot
authors.affiliation: Inserm UMR-S 942, Paris, France; Université Paris Diderot, PRES Sorbonne Paris Cité, department of anaesthesiology and critical care medicine, AP-HP, Saint-Louis Lariboisière university hospitals, 2, rue Ambroise-Paré, 75010 Paris, France. Electronic address: etienne.gayat@aphp.fr.
authors.forename: E
authors.initials: E
authors.lastname: Gayat
authors.affiliation: University of Tunis El Manar, department of anaesthesiology and critical care medicine, military hospital of Tunis, Tunis, Tunisia. Electronic address: mustapha.ferjani@planet.tn.
authors.forename: M
authors.initials: M
authors.lastname: Ferjani
authors.affiliation: Inserm UMR-S 942, Paris, France; Université Paris Diderot, PRES Sorbonne Paris Cité, department of anaesthesiology and critical care medicine, AP-HP, Saint-Louis Lariboisière university hospitals, 2, rue Ambroise-Paré, 75010 Paris, France. Electronic address: alexandre.mebazaa@aphp.fr.
authors.forename: A
authors.initials: A
authors.lastname: Mebazaa
mesh_terms: D000328:Adult; D000368:Aged; D016280:Atrial Function, Right / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D009202:Cardiomyopathies / Q000150:complications* / Q000000981:diagnostic imaging; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D002404:Catheterization; D004452:Echocardiography; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D049590:Postpartum Period; D011651:Pulmonary Artery / Q000503:physiopathology; D011724:Pyridazines / Q000627:therapeutic use*; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000188:drug therapy* / Q000209:etiology*; D000077464:Simendan; D013318:Stroke Volume / Q000187:drug effects
chemical_list: D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan
keywords: Cardiogenic shock; Congestion; Inotropic agents; Levosimendan; Postpartum cardiomyopathy