Background: Levosimendan, a novel inodilator, has been shown to improve hemodynamic function in patients with decompensated heart failure with preserved arterial blood pressure. Data on its use in patients with cardiogenic shock are scarce. The present series describes the 24-h hemodynamic effects of levosimendan as add-on therapy in patients with cardiogenic shock. Methods: Levosimendan was administered for 24 hours (dose ranging from 0.05 to 0.2μg/kg/min), in addition to catecholamines, in 25 patients who suffered from cardiogenic shock after acute myocardial infarction. Hemodynamic measurements were performed at baseline (prior to levosimendan infusion) and at 24 hours after initiation of levosimendan. Results: Hemodynamic improvement was evident only in patients (Group 1, n=13) with increased systematic vascular resistance (SVR>18Wood). Levosimendan administration increased the cardiac index ( 2.1±0.4 l/min/m2 from 1.5±0.3l/min/m2, p=0.002) and cardiac power (0.645±0.179W from 0.462±0.164W, p=0.022) and decreased SVR (21±6.7Wood from 23±5Wood, p=0.001) and pulmonary cappillary wedge pressure (16±11mmHg from 23±5mmHg, p=0.059). On the other hand, patients with low systemic vascular resistance (SVR<19Wood)) (Group B, n=12 ) did not have hemodynamic improvement with levosimendan administration. Conclusions: Levosimendan infusion added to catecholamines in patients with cardiogenic shock after myocardial infarction exerts hemodynamic benefit only in the subgroup of patients with high SVR.

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