Enhancement of Myocardial Function and Reduction of Injury with Levosimendan after Percutaneous Coronary Intervention for Acute Myocardial Infarction: A Pilot Study

Abstract

Objectives: To determine the short-term clinical effects of levosimendan in acute myocardial infarction (AMI) patients with myocardial stunning after emergency percutaneous coronary intervention (PCI). Methods: The study population consisted of 30 patients with AMI who received emergency PCI and satisfied the inclusion criteria. Levosimendan was given as a continuous infusion of 0.1 μg/kg/min for 24 h, and the remaining 10 patients received placebo treatment. The patients were observed with invasive haemodynamic monitoring and were evaluated biochemically and echocardiographically before and after the drug infusion. Results: Following treatment, biochemical indices (not including creatine kinase and its MB fraction) were significantly lower in the levosimendan group than in the placebo group. Meanwhile, left-ventricular (LV) end-systolic volume, mean pulmonary arterial pressure, pulmonary capillary wedge pressure and systemic vascular resistance were significantly reduced in the levosimendan group, whereas the early-to-late diastolic velocities ratio, LV ejection fraction, cardiac index and cardiac power index were increased. Troponin I levels were reduced and fewer stunned and infarction segments were observed in the patients treated with levosimendan. Conclusions: Levosimendan can significantly improve the myocardium function of patients with myocardial stunning after PCI.

Levosimendan Versus Dobutamine in Myocardial Injury Patients with Septic Shock: A Randomized Controlled Trial

“…But HFABP, TNI, and BNP were lower in the levosimendan group than in the dobutamine group, which suggested that levosimendan could play a more important role in attenuating septic myocardial injury. Wu et al [ 29 ] conducted a study in patients with acute myocardial infarction (AMI) who received emergency percutaneous coronary intervention (PCI) and found that the TNI concentration decreased much more in the levosimendan group than in the placebo group, suggesting that the myocardium was suffering less damage. In myocardium injury and stunning, the activation of the Ca 2+ -dependent protease results in degradation of TNI partially and selectively during reperfusion [ 30 ].…”

“…In myocardium injury and stunning, the activation of the Ca 2+ -dependent protease results in degradation of TNI partially and selectively during reperfusion [ 30 ]. Because levosimendan has the ability to increase responsiveness to calcium while keeping the cytosolic Ca 2+ concentration unchanged, levosimendan prevented the degradation of TNI, which could prevent the contractile dysfunction of myocardium stunning and damage [ 29 ].…”

Comparison of the Effects of Levosimendan Dobutamine and Vasodilator Therapy on Ongoing Myocardial Injury in Acute Decompensated Heart Failure

“…Many clinical studies on ADHF indicate that LEV improves myocardial function, reduces the cTn levels, and suppresses inflammation and apoptotic indicators of both intense myocardial ischemia and stunned myocardium after myocardial infarction. 24 -27 In addition, lower levels of cTn release during LEV administration and improving myocardial performance indicators have been reported. 28 -30…”

The effect of levosimendan on myocardial ischemia–reperfusion injury in streptozotocin-induced diabetic rats

“…Although the exact mechanism has not been clarified, the higher IL6 and CRP levels in patients exhibiting myocardial stunning may serve as a link between inflammation and ischemia–reperfusion injury followed by stunning ( 24 – 26 ). In a pilot study, Wu et al ( 27 ) investigated levosimendan effects on patients with acute myocardial infarction (AMI) who underwent percutaneous coronary intervention (PCI). Patients in the levosimendan group received levosimendan at a continuous infusion dose of 0.1 µg/kg/min for 24 h, and the remaining 10 patients received placebo treatment.…”