Levosimendan accelerates recovery in patients with takotsubo cardiomyopathy

Yaman, Mehmet; Arslan, Uğur; Kaya, Ahmet; Akyol, Aytaç; Öztürk, Fatih; Okudan, Yunus Emre; Bayramoğlu, Adil; Bektaş, Osman

doi:10.5603/cj.a2016.0100

Cited by 31 publications

(19 citation statements)

References 26 publications

(34 reference statements)

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“…Individually, these studies do not provide adequately powered insights into any effect of levosimendan on survival in this situation but they have produced repeated indications of favourable effects on systemic haemodynamics and on left ventricular function and wall motion. In conjunction with the latter, several reports have documented accelerated recovery from Takotsubo cardiomyopathy (transient left ventricular apical ballooning syndrome) with levosimendan, accompanied by favourable haemodynamic responses and more rapid restoration of pre-incident troponin levels 32 , 33 …”

Section: Levosimendan In Acute Heart Failure Complicating Acute Coronmentioning

confidence: 99%

Use of levosimendan in acute heart failure

Harjola

Giannakoulas

Lewinski

et al. 2018

European Heart Journal Supplements

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As a calcium sensitizer and inodilator that augments cardiac contractility without increasing myocardial oxygen demand or exacerbating ischaemia, levosimendan may be well configured to deliver inotropic support in cases of acute heart failure (AHF). Other factors favouring levosimendan in this setting include its extended duration of action due to the formation of an active metabolite and the lack of any attenuation of effect in patients treated with beta-blockers. Effects of levosimendan on systemic haemodynamics include its significant, dose-dependent increases in cardiac output, stroke volume and heart rate, and decreases in right and left ventricular filling and total peripheral resistance. Rapid and sustained reduction in levels of natriuretic peptides is a consistent effect of levosimendan use and potentially favourable effects on other neurohormonal indicators of cardiac distress are also observed. Levosimendan has repeatedly been shown to be effective in relief of symptoms of AHF, notably dyspnoea and fatigue, while mortality data from clinical trials and registries suggest that levosimendan is markedly less likely than catecholaminergic inotropes to worsen prognosis. The vasodilator pharmacology of levosimendan is also pertinent to the drug’s use in AHF, in which setting organ under-perfusion is often a key pathology. These considerations suggest that levosimendan may have a more favourable impact on the circumstances of the majority of AHF patients than adrenergic agents that act only or primarily as cardiac stimulants. They also suggest that levosimendan may advantageously be integrated into a comprehensive strategy of early intervention designed and intended to prevent cardiac destabilization worsening to the point where hospitalization is necessary. Levosimendan should be used with caution and with tightened haemodynamic monitoring in patients who have low baseline blood pressure (systolic blood pressure <100 mmHg; diastolic blood pressure <60 mmHg), or who are at risk of a hypotensive episode.

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Section: Levosimendan In Acute Heart Failure Complicating Acute Coronmentioning

confidence: 99%

Use of levosimendan in acute heart failure

Harjola

Giannakoulas

Lewinski

et al. 2018

European Heart Journal Supplements

View full text Add to dashboard Cite

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“…Vasoactive amines should be avoided in the management of these patients because they already have high catecholamine levels causing myocardial dysfunction and they might be relatively insensitive to their action due to long-term exposure (as previously explained). Some argue that inodilators such as levosimendan and milrinone could be good alternatives because they act through non-adrenergic pathways, providing inotropic support and relieving afterload (12, 14). Levosimendan has been used successfully with few adverse events in small studies (14, 15), none of them included patients with PPGL.…”

Section: Discussionmentioning

confidence: 99%

“…Some argue that inodilators such as levosimendan and milrinone could be good alternatives because they act through non-adrenergic pathways, providing inotropic support and relieving afterload (12, 14). Levosimendan has been used successfully with few adverse events in small studies (14, 15), none of them included patients with PPGL. There are two case reports of patients with PPGLwho were treated with levosimendan with good results (one also with dobutamine and the other with vasopressin also) (16, 17).…”

Section: Discussionmentioning

confidence: 99%

Paraganglioma presenting as stress cardiomyopathy: case report and literature review

Ferreira

Silva

Alegria

et al. 2019

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Summary Pheochromocytoma/paraganglioma (PPGL) are neuroendocrine tumors that can secrete catecholamines. The authors describe a challenging case who presented as stress cardiomyopathy and myocardial infarction (MI). A 76-year-old man, with a medical history of Parkinson’s disease, type 2 diabetes mellitus, hypertension, dyslipidaemia and a previous inferior MI in 2001, presented to the emergency department due to chest pain, headaches and vomiting. He also reported worsening blood glucose levels and increasing constipation over the preceding weeks. BP was 185/89 mmHg (no other relevant findings). EKG had ST segment depression in leads V2-V6, T troponin was 600 ng/L (<14) and the echocardiogram showed left ventricular hypokinesia with mildly compromised systolic function. Nevertheless, he rapidly progressed to severe biventricular dysfunction. Coronary angiogram showed a 90% anterior descendent coronary artery occlusion (already present in 2001), which was treated with angioplasty/stenting. In the following days, a very labile BP profile and unexplained sinus tachycardia episodes were observed. Because of sustained severe constipation, the patient underwent an abdominal CT that revealed a retroperitoneal, heterogeneous, hypervascular mass on the right (62 × 35 mm), most likely a paraganglioma. Urinary metanephrines were increased several fold. 68Ga-DOTANOC PET-CT scan showed increased uptake in the abdominal mass (no evidence of disease elsewhere). He was started on a calcium-channel blocker and alpha blockade and underwent surgery with no major complications. Eight months after surgery, the patient has no evidence of disease. Genetic testing was negative for known germline mutations. This was a challenging diagnosis, but it was essential for adequate cardiovascular stabilization and to reduce further morbidity. Learning points: PPGL frequently produces catecholamines and can manifest with several cardiovascular syndromes, including stress cardiomyopathy and myocardial infarction. Even in the presence of coronary artery disease (CAD), PPGL should be suspected if signs or symptoms attributed to catecholamine excess are present (in this case, high blood pressure, worsening hyperglycaemia and constipation). Establishing the correct diagnosis is important for adequate treatment choice. Inodilators and mechanical support might be preferable options (if available) for cardiovascular stabilization prior to alpha blockade and surgery. Laboratory interference should be suspected irrespective of metanephrine levels, especially in the context of treated Parkinson’s disease.

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“…A further mechanism that may have contributed to acute ventricular dysfunction includes LBBB development 4 . Moreover, an overlapping takotsubo cardiomyopathy or phaeochromocytoma cannot be excluded although either apical ballooning or hypertensive crisis were observed during VA episodes 5 . The management of these dramatic VA attacks is challenging, and no specific recommendations exist in recent cardiologic guidelines on the pharmacological strategy (inotropic/vasopressor agents) to adopt for this acute clinical setting 3 .…”

Section: Discussionmentioning

confidence: 99%

Treatment of refractory vasospastic angina complicated by acute pulmonary oedema with levosimendan: a case report

Moltrasio

Cosentino

Conte

et al. 2019

European Heart Journal - Case Reports

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Background Vasospastic angina (VA) is an important cause of chest pain and patients often have 3- to 6-month clusters of recurrent attacks, separated by relatively asymptomatic periods. During these episodes the resulting myocardial ischaemia can lead to clinical complications of different severity, including acute myocardial infarction, acute heart failure, and cardiogenic shock. The management of severe and recurrent VA attacks is challenging, and no specific recommendations exist in recent cardiologic guidelines on the pharmacological strategy (inotropic/vasopressor agents) to adopt for this acute clinical setting. Case summary We present a case of recurrent episodes of VA complicated by acute pulmonary oedema and cardiogenic shock despite maximal tolerated therapy (intravenous calcium antagonist and nitrates) that was successfully treated with levosimendan. Discussion Levosimendan rapidly reverted cardiogenic shock, acute pulmonary oedema, and mitral regurgitation caused by a refractory coronary spasm, contributing to persistent clinical stabilization. Further evidence and a longer follow-up are needed to support our observation on the efficacy of levosimendan in this specific clinical setting.

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Levosimendan accelerates recovery in patients with takotsubo cardiomyopathy

Abstract: (Cardiol J 2016; 23, 6: 610-615)

Cited by 31 publications

References 26 publications

Use of levosimendan in acute heart failure

Use of levosimendan in acute heart failure

Paraganglioma presenting as stress cardiomyopathy: case report and literature review

Treatment of refractory vasospastic angina complicated by acute pulmonary oedema with levosimendan: a case report

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