Hemodynamic improvement following levosimendan treatment in patients with acute myocardial infarction and cardiogenic shock *

Ruß, Martin; Prondzinsky, Roland; Christoph, Arnd; Schlitt, Axel; Buerke, Ute; Söffker, Gerold; Lemm, Henning; Swyter, Michael; Wegener, Nikolas; Winkler, Mathias; Carter, Justin M.; Reith, Sebastian; Werdan, Karl; Buerke, Michael

doi:10.1097/00003246-200712000-00010

Cited by 23 publications

(24 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Trotz der vasodilatierenden Eigenschaften von Levosimendan und dem damit verbundenen Risiko eines MAP-Abfalls zeigen neuere Studien positive Effekte in der Therapie des kardiogenen Schocks, wenn [36,71,76,78].…”

Section: Kardiogener Und Septischer Schockunclassified

Role of Levosimendan in intensive care treatment of myocardial insufficiency

Rehberg¹,

Ertmer²,

Aken³

et al. 2007

Anaesthesist

View full text Add to dashboard Cite

Levosimendan is a calcium sensitizer that is currently in the focus of intensive care medicine because it may be superior to standard inotropic agents in the treatment of acute myocardial insufficiency. The effects of levosimendan mainly depend on three predominant mechanisms: 1) positive inotropic effect by increasing the sensitivity of cardiac myofilaments to calcium ions, 2) vasodilatory effect by stimulation of adenosine triphosphate-sensitive potassium channels and 3) inhibition of phosphodiesterase-III. In a large number of experimental and clinical studies further possible indications for levosimendan have been described, e.g. cardioprotection during ischemia, cardiogenic shock, septic myocardial insufficiency and pulmonary hypertension. This review article critically summarizes the current scientific and clinical knowledge about levosimendan, its pharmacologic characteristics, mechanisms of action as well as indications and potential risks.

show abstract

Section: Kardiogener Und Septischer Schockunclassified

Role of Levosimendan in intensive care treatment of myocardial insufficiency

Rehberg¹,

Ertmer²,

Aken³

et al. 2007

Anaesthesist

View full text Add to dashboard Cite

show abstract

“…In our own study, we showed that in patients with cardiogenic shock who did not respond properly to dobutamine and norepinephrine, the additional administration of levosimendan resulted in significant hemodynamic improvement within a few hours [25]. Likewise, we showed that levosimedan treatment resulted in faster hemodynamic improvement when compared to IABP treatment [4].…”

Section: Levosimendanmentioning

confidence: 72%

Pathophysiology, diagnosis, and treatment of infarction-related cardiogenic shock

Buerke

Lemm

Dietz

et al. 2011

Herz

View full text Add to dashboard Cite

Cardiogenic shock is characterized by inadequate tissue perfusion due to cardiac dysfunction, and it is often caused by acute myocardial infarction. The mortality rate in patients with cardiogenic shock is still very high (i.e., 50-60%). The pathophysiology of cardiogenic shock involves a vicious spiral circle: ischemia causes myocardial dysfunction, which in turn aggravates myocardial ischemia. Myocardial stunning and/or hibernating myocardium can enhance myocardial dysfunction, thus, worsening the cardiogenic shock. Low perfusion pressures with global ischemia leads to multiorgan dysfunction. Ischemia and reperfusion can result in systemic inflammation or within the first few days sepsis due to the translocation of bacteria or bacterial toxins from the intestines, which can result in increased mortality. The key to an optimal treatment of cardiogenic shock patients is a structured approach: (1) rapid diagnosis and prompt initiation of therapy to increase blood pressure and augment cardiac output with subsequently improved perfusion. (2) Rapid coronary revascularization is of critical importance. Using this approach, mortality can be reduced. In many hospitals, initial stabilization is achieved by intraaortic balloon counterpulsation (IABP). However, evidence for improved survival from randomized studies on the use of IABP in combination with PCI is lacking. (3) In order to achieve adequate perfusion, dobutamine and sometimes in combination with norepinephrine might be necessary. Recent studies have shown that the calcium sensitizer levosimendan in cardiogenic shock can be a useful addition to medical therapy. In this overview, epidemiology, pathophysiology, and guideline-oriented treatment strategies for cardiogenic shock are presented.

show abstract

“…34 The use of this drug in STEMI cases complicated by cardioplegic shock has been investigated only in small studies (Table 3); therefore further studies are warranted. 35 Levosimendan administered after primary PCI in patients with LV dysfunction produces signifi cantly better improvement in clinical and hemodynamic parameters than both placebo and dobutamine. 29,31 In cases with persisting shock despite successful revascularization by PCI due to cardiogenic shock, lowdose levosimendan (0.05-0.2 μg/kg/min per 24 h) is reported to induce a positive inotropic effect without causing hypotension.…”

Section: Use Of Levosimendan In Patients Undergoing Percutaneous Coromentioning

confidence: 98%

Use of levosimendan in patients with ischemic heart disease following mechanical reperfusion

Kurt

2009

Surg Today

View full text Add to dashboard Cite

Cardiac failure is among the most significant conditions associated with acute coronary syndrome. In ischemic heart disease, serious hemodynamic problems are reported in patients with left ventricular dysfunction during the acute phase despite mechanical revascularization. Several positive inotropic agents in addition to intra-aortic balloon pump (IABP) are required to support patients with impaired left ventricular pump function during this phase. Intravenous inotropic agents, beta-mimetics, and phosphodiesterase inhibitors lead to increases in the incidence of arrhythmia and myocardial O(2) consumption owing to their effect of increasing intracellular calcium amount, although they produce rapid hemodynamic improvements in cardiac failure. This causes severe problems particularly in cardiac failure of ischemic origin. Recently, levosimendan, a calcium-sensitizing agent with cardioprotective properties, is being used alone or in combination with IABP in cases with severe left ventricular systolic dysfunction during mechanical revascularization procedures (percutaneous coronary interventions, coronary bypass surgery). This review includes studies with levosimendan in cases not recovering due to myocardial stunning in the acute phase despite mechanical approaches applied.

show abstract

Hemodynamic improvement following levosimendan treatment in patients with acute myocardial infarction and cardiogenic shock *

Cited by 23 publications

References 27 publications

Role of Levosimendan in intensive care treatment of myocardial insufficiency

Role of Levosimendan in intensive care treatment of myocardial insufficiency

Pathophysiology, diagnosis, and treatment of infarction-related cardiogenic shock

Use of levosimendan in patients with ischemic heart disease following mechanical reperfusion

Contact Info

Product

Resources

About