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

Abstract

BackgroundWe aimed to investigate the effect of levosimendan on biomarkers of myocardial injury and systemic hemodynamics in patients with septic shock.Material/MethodsAfter achieving normovolemia and a mean arterial pressure of at least 65 mmHg, 38 septic shock patients with low cardiac output (left ventricular ejective fraction), LEVF ≤45%) were randomly divided into two groups: levosimendan dobutamine. Patients in the levosimendan and dobutamine groups were maintained with intravenous infusion of levosimendan (0.2 μg/kg/minute) and dobutamine (5 μg/kg/minute) for 24 hours respectively. During treatment we monitored hemodynamics and LVEF, and measured levels of heart-type fatty acid binding protein (HFABP), troponin I (TNI), and brain natriuretic peptide(BNP). In addition, the length of mechanical ventilation, intensive care unit (ICU) stay, hospital stay, and 28-day mortality were compared between the two groups.ResultsThe levosimendan group and the dobutamine group were well matched with respect to age (years, 55.4±1 7.5 versus 50.2±13.6) and gender (males, 68.4% versus 57.9%). Levosimendan-treated patients had higher stroke volume index (SVI), cardiac index (CI), LVEF, and left ventricular stroke work index (LVSWI), and lower extravascular lung water index (EVLWI) compared to dobutamine-treated patients (p<0.05). HFABP, TNI, and BNP in the levosimendan group were less than in the dobutamine group (p<0.05). There was no difference in the mechanical ventilation time, length of stay in ICU and hospital, and 28-day mortality between the two groups.ConclusionsCompared with dobutamine, levosimendan reduces biomarkers of myocardial injury and improves systemic hemodynamics in patients with septic shock. However, it does not reduce the days on mechanical ventilation, length of stay in ICU and hospital, or 28-day mortality.

The Correlation Between Whole Blood Copper and Zinc Levels and Sepsis-Induced Left Ventricular Systolic Dysfunction (SILVSD) in Patients with Septic Shock: A Single-Center Prospective Observational Study

“…The TRF-Fe 3+ -compound can scavenge reactive oxygen species (ROS) because it exerts anantioxidant glutathione-peroxidase activity (33). It is reported that IL-1 and IL-6 can upregulate the synthesis of Cp in the liver (34), which supports our nding that a signi cant positive correlation exists between whole blood Cu and NT-proBNP, TNT, PCT and HFABP that re ects cardiac function and myocardial injury in septic shock (11). We speculate that this also may explain the phenomenon that elevated serum Cu concentrations existed in septic patients to some extent.…”

“…Cardiac speci c injury biomarkers such as troponin(cTNI, cTNT) and heart-type fatty acid binding protein(HFABP) has been studied in patients with septic shock and elevated TNI and HFABP are related to poor prognosis (11,12). However, the results of these studies exploring the impact of TNI levels for SIMD show difference.…”

Effects of Early Continuous Venovenous Hemofiltration on E-Selectin, Hemodynamic Stability, and Ventilatory Function in Patients with Septic-Shock-Induced Acute Respiratory Distress Syndrome

“…First, CVVH could contribute to fluid removal by achieving a negative fluid balance [30]. Increased EVLW worsened lung edema and predicted mortality in severe sepsis and septic shock [31, 32] and aggravated ALI/ARDS [7]. A negative fluid balance was found to be associated with decreased EVLW [33].…”

Levosimendan in the treatment of patients with acute cardiac conditions: an expert opinion of the Association of Intensive Cardiac Care of the Polish Cardiac Society

“…In comparison with dobutamine, levosimendan improved hepatic blood flow through both hepatic artery (increased arterial perfusion and reduced hepatic artery resistance) and portal venous system (increased portal vein flow and reduced portal hypertension). 89,90 Levosimendan in untypical forms of acute heart failure: takotsubo syndrome, peripartum cardiomyopathy, and β -blocker or calcium channel blocker toxicity Adrenergic agonists, such as catecholamines or phosphodiesterase inhibitors, are generally contraindicated in cardiogenic shock complicating Takotsubo syndrome. 91 Therefore, apart from temporary mechanical circulatory support, successful treatment options include also levosimendan.…”