Effect of levosimendan on right ventricular systolic and diastolic functions in patients with ischaemic heart failure

Duygu, Hamza; Özerkan, Filiz; Zoghi, Mehdi; Nalbantgil, Sanem; Yıldız, Ahmet; Akilli, Azem; Akın, Mustafa; Nazlı, Cem; Ergene, Oktay

doi:10.1111/j.1742-1241.2007.01510.x

Cited by 35 publications

(32 citation statements)

References 20 publications

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“…Levosimendan improves RV-PA coupling in experimental acute RV failure [187-189] more than dobutamine [188]. These effects have been shown clinically with improvements in RV function and reduction in PVR in ischemic RV failure [190-194], ARDS [195], and after mitral valve replacement surgery [196,197]. In chronic PH, repetitive doses reduce mPAP and PVR from baseline and improve SvO 2 [198].…”

Section: Resultsmentioning

confidence: 99%

Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review

et al. 2010

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IntroductionPulmonary vascular dysfunction, pulmonary hypertension (PH), and resulting right ventricular (RV) failure occur in many critical illnesses and may be associated with a worse prognosis. PH and RV failure may be difficult to manage: principles include maintenance of appropriate RV preload, augmentation of RV function, and reduction of RV afterload by lowering pulmonary vascular resistance (PVR). We therefore provide a detailed update on the management of PH and RV failure in adult critical care.MethodsA systematic review was performed, based on a search of the literature from 1980 to 2010, by using prespecified search terms. Relevant studies were subjected to analysis based on the GRADE method.ResultsClinical studies of intensive care management of pulmonary vascular dysfunction were identified, describing volume therapy, vasopressors, sympathetic inotropes, inodilators, levosimendan, pulmonary vasodilators, and mechanical devices. The following GRADE recommendations (evidence level) are made in patients with pulmonary vascular dysfunction: 1) A weak recommendation (very-low-quality evidence) is made that close monitoring of the RV is advised as volume loading may worsen RV performance; 2) A weak recommendation (low-quality evidence) is made that low-dose norepinephrine is an effective pressor in these patients; and that 3) low-dose vasopressin may be useful to manage patients with resistant vasodilatory shock. 4) A weak recommendation (low-moderate quality evidence) is made that low-dose dobutamine improves RV function in pulmonary vascular dysfunction. 5) A strong recommendation (moderate-quality evidence) is made that phosphodiesterase type III inhibitors reduce PVR and improve RV function, although hypotension is frequent. 6) A weak recommendation (low-quality evidence) is made that levosimendan may be useful for short-term improvements in RV performance. 7) A strong recommendation (moderate-quality evidence) is made that pulmonary vasodilators reduce PVR and improve RV function, notably in pulmonary vascular dysfunction after cardiac surgery, and that the side-effect profile is reduced by using inhaled rather than systemic agents. 8) A weak recommendation (very-low-quality evidence) is made that mechanical therapies may be useful rescue therapies in some settings of pulmonary vascular dysfunction awaiting definitive therapy.ConclusionsThis systematic review highlights that although some recommendations can be made to guide the critical care management of pulmonary vascular and right ventricular dysfunction, within the limitations of this review and the GRADE methodology, the quality of the evidence base is generally low, and further high-quality research is needed.

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Section: Resultsmentioning

confidence: 99%

Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review

et al. 2010

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“…Inotropes, including epinephrine, milrinone and dobutamine, are frequently needed to augment contractility; however, milrinone and dobutamine may worsen systemic hypotension, requiring the addition of vasopressors [23,50,51]. Newer inotropes such as levosimendan have demonstrated improvements in parameters of RV function in animal models and early human studies [52,53]; however, their routine use in decompensated RV failure requires further investigation.…”

Section: Improving Right Ventricular Contractilitymentioning

confidence: 99%

Trying to succeed when the right ventricle fails

McDonald

Ross

2009

Current Opinion in Cardiology

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“…In studies comparing levosimendan and dobutamine, some showed significant improvement in LVEF [15,20,21] both with levosimendan and dobutamine, but in a study in which patients were treated with carvedilol [17], the dobutamine group did not show an improvement in LVEF. In our study, LVEF significantly improved in the levosimendan group, but not in the dobutamine group.…”

Section: Discussionmentioning

confidence: 99%

“…Studies comparing levosimendan and dobutamine using echocardiographic parameters generally performed a second echocardiographic examination just after inotrope infusions [15][16][17]. We performed echocardiographic measurements 5 days after the initiation of infusions to determine whether the favorable effects of the levosimendan and dobutamine continue following infusions.…”

Section: Discussionmentioning

confidence: 99%

Assessment of sustained effects of levosimendan and dobutamine on left ventricular systolic functions by using novel tissue Doppler derived indices in patients with advanced heart failure

Oner

Ertürk²,

Birant³

et al. 2015

Cardiol J

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Effect of levosimendan on right ventricular systolic and diastolic functions in patients with ischaemic heart failure

Abstract: Levosimendan improves right ventricular systolic and diastolic functions.

Cited by 35 publications

References 20 publications

Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review

Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review

Trying to succeed when the right ventricle fails

Assessment of sustained effects of levosimendan and dobutamine on left ventricular systolic functions by using novel tissue Doppler derived indices in patients with advanced heart failure

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