Neurohumoral improvement and torsional dynamics in patients with heart failure after treatment with levosimendan

Abstract

BackgroundLevosimendan improves clinical and hemodynamic parameters exerting an anti-inflammatory and antiapoptotic effect in decompensated heart failure. The aim of this study was to evaluate the effects of levosimendan on LV torsion, plasma levels of NT-proBNP and on the balance between pro-inflammatory (TNF-α, IL-6) and anti-inflammatory cytokines (IL-10).MethodsWe enrolled 24 patients (age 62 ± 7 years) with acute HF, NYHA class IV and severe LV dysfunction. All patients underwent transthoracic echocardiography using two-dimensional speckle tracking analysis to detect LV twist angle (LVTA), at baseline and 1 week after treatment with levosimendan infusion. Biochemical parameters (pro-BNP, IL-6, IL-10, TNF-α) were determined by enzyme-linked immunosorbent (ELISA).ResultsAfter one week, we observed an improvement in LV function especially in LVTA (4.15 ± 2.54 vs 2.9 ± 2.1 p < 0.01), in LV ejection fraction (27.3 ± 8.04 vs 21.6 ± 6.8 p = 0.03) and also a significant reduction in BNP levels (1844 ± 560 vs 4713 ± 1050, p = 0.03). The multiple linear regression analysis showed a significant relation between a reduction of TNF α/IL-10 ratio (Δ > 20%) and BNP (Δ > 40%), LVEF (Δ > 10%) and LVTA (Δ > 20%) (O.R. 1.77, 95% C.I. 1.11–2.83; O.R. 1.49, 95% C.I. 1.08–2.67; O.R. 1.66, 95% C.I. 1.10–2.74, respectively, confirmed p, all < 0.01 by Hosmer–Lemeshov confirmation and the formal test for interaction).ConclusionsLevosimendan exerts a hemodynamic effect by improving EF and LV torsion in patients with acute HF in association with a positive effect on the balance between pro and anti-inflammatory cytokines.

Effects of levosimendan in heart failure: The role of echocardiography

“…Increase of left ventricular ( LV ) twist angle after levosimendan infusion in patients with heart failure. This graph shows that after levosimendan infusion in patients with heart failure LV twist angle increases…”

“…The anatomy of LV is significantly altered in HF, with a spherical architecture and a subversion of the normal oblique pattern of the fibers. This causes a reduction of LV torsional motion which is the primum movens of an increased endocardial stress that consequently leads to a surge in the oxygen requirement, leading to a gradual impairment of LV systolic function . Treatment with levosimendan has proved to increase LVEF and torsional motion in the setting of AHF (Figure ) .…”

“…This causes a reduction of LV torsional motion which is the primum movens of an increased endocardial stress that consequently leads to a surge in the oxygen requirement, leading to a gradual impairment of LV systolic function . Treatment with levosimendan has proved to increase LVEF and torsional motion in the setting of AHF (Figure ) . The inotropic action of levosimendan influences the indexes of systolic function starting from 1 week by the end of the treatment …”

Low-Cost Impedance Measurements for Lab-on-a-Chip Architectures: Towards Potentiostat Miniaturization

“…Bioelectronic devices such as left ventricle assisted devices (LVADs) cause many secondary effects in patients, triggering increased inflammatory cytokine levels, e.g., Interleukin 1 (IL-1), IL-10 and tumor necrosis factor α (TNF-α). Traditional techniques for the detection of CVD cytokines, such as enzyme-linked immunosorbent assays (ELISA), although accurate and sensitive, still require specialized personnel and high volumes of sample for analysis [2,3]. In this light, several electrochemical biosensors have been developed for the monitoring of inflammatory cytokines [4,5].…”

Short‐term effects of levosimendan on strain/strain rate markers in patients with nonischemic dilated cardiomyopathy

“…Navarri et al showed an increase in LVEF and LV torsional dynamics in patients with acute HF after levosimendan therapy 22. It can demonstrate the myocardial tissue deterioration long before EF starts decreasing.…”