Preoperative Levosimendan. A New Way for Organoprotection

L, Guerrero Orriach Jose; Fernández, A; Iglesias, Pilar Paniagua; Galán, María; Melero, J M; Flórez, Adriana; Escalona, J J; Rodríguez, María Juliana; Ramirez, Marcellus Francis; Rubio, María Dolores Mesa; Cruz, Julia M.

doi:10.2174/1381612820666140325121452

Cited by 7 publications

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“…The drug exerts its cardioprotective effect through several mechanisms: it reduces preload and afterload, thus improving cardiac work, and its action on the ATP potassium-sensitive channels in the mitochondria of cardiac cells protects the heart against myocardial ischemia by achieving cell stabilization and preserving homeostasis, thanks to the correction of the mitochondrial function. 1 , 2 …”

Section: Discussionmentioning

confidence: 99%

“…Besides cardioprotection against ischemic events and the antistunning effect, levosimendan may also reduce ischemia-related damage in other organs. 1 In this study, we evaluated its effect on the heart, kidney, and central nervous system.…”

Section: Discussionmentioning

confidence: 99%

“…Levosimendan is an inotropic agent with vasodilatory and protective effects, acting via the calcium channels in cardiac myofilaments and the opening of adenosine triphosphate (ATP)-sensitive potassium channels in vascular smooth muscle cells and ATP-sensitive potassium channels in cardiac mitochondria. 1 …”

Section: Introductionmentioning

confidence: 99%

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Cardiac, renal, and neurological benefits of preoperative levosimendan administration in patients with right ventricular dysfunction and pulmonary hypertension undergoing cardiac surgery: evaluation with two biomarkers neutrophil gelatinase-associated lipocalin and neuronal enolase

Guerrero-Orriach¹,

Ariza-Villanueva²,

Florez-Vela³

et al. 2016

TCRM

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PurposeTo evaluate if the preoperative administration of levosimendan in patients with right ventricular (RV) dysfunction, pulmonary hypertension, and high perioperative risk would improve cardiac function and would also have a protective effect on renal and neurological functions, assessed using two biomarkers neutrophil gelatinase-associated lipocalin (N-GAL) and neuronal enolase.MethodsThis is an observational study. Twenty-seven high-risk cardiac patients with RV dysfunction and pulmonary hypertension, scheduled for cardiac valve surgery, were prospectively followed after preoperative administration of levosimendan. Levosimendan was administered preoperatively on the day before surgery. All patients were considered high risk of cardiac and perioperative renal complications. Cardiac function was assessed by echocardiography, renal function by urinary N-GAL levels, and the acute kidney injury scale. Neuronal damage was assessed by neuron-specific enolase levels.ResultsAfter surgery, no significant variations were found in mean and SE levels of N-GAL (14.31 [28.34] ng/mL vs 13.41 [38.24] ng/mL), neuron-specific enolase (5.40 [0.41] ng/mL vs 4.32 [0.61] ng/mL), or mean ± SD creatinine (1.06±0.24 mg/dL vs 1.25±0.37 mg/dL at 48 hours). RV dilatation decreased from 4.23±0.7 mm to 3.45±0.6 mm and pulmonary artery pressure from 58±18 mmHg to 42±19 mmHg at 48 hours.ConclusionPreoperative administration of levosimendan has shown a protective role against cardiac, renal, and neurological damage in patients with a high risk of multiple organ dysfunctions undergoing cardiac surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Cardiac, renal, and neurological benefits of preoperative levosimendan administration in patients with right ventricular dysfunction and pulmonary hypertension undergoing cardiac surgery: evaluation with two biomarkers neutrophil gelatinase-associated lipocalin and neuronal enolase

Guerrero-Orriach¹,

Ariza-Villanueva²,

Florez-Vela³

et al. 2016

TCRM

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“…Heart failure (HF) is currently one of the most significant causes of mortality and morbidity [1,2]. Although advances have been made in the treatment of HF, the morbidity and mortality rates associated with acute decompensated HF (ADHF) remain high [3].…”

Section: Introductionmentioning

confidence: 99%

Comparative assessment of the effects of dobutamine and levosimendan on right ventricular ejection fraction in patients with biventricular heart failure

Kaplangöray

Aydin

2023

Kardiologiia

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Aim The primary objective of this study was to comparatively assess the effects of levosimendan and dobutamine on RVEF, right ventricular diastolic function, and hormonal balance in patients with biventricular heart failure. The secondary objective was to investigate the relationship between the RVEF and the peak systolic velocity (Sa), an indicator of right ventricular systolic function, as measured by tissue Doppler echocardiography from the tricuspid annulus, and by the tricuspid annular plane systolic excursion (TAPSE).Material and Methods The population of this cross-sectional, single-center, prospective study was comprised of 81 patients, who between December 2019 and January 2022, applied to the study health institution with diagnosis of ADHF. The study sample included 67 biventricular heart failure patients with left ventricular ejection fraction (LVEF) <35 % and RVEF <50 %, as measured by the ellipsoidal shell model, and who met the other study inclusion criteria. Of these 67 patients, 34 were treated with levosimendan, and 33 were treated with dobutamine. RVEF, LVEF, Sa, peak early (Ea) and peak late (Aa) annular velocities, Ea / Aa ratio, TAPSE, systolic pulmonary artery pressure (SPAP), n-terminal pro-brain natriuretic peptide (NT-pro BNP), and functional capacity (FC) were measured before treatment and at 48 hrs of treatment. The within group pre- and post-treatment differences (Δs) of these variables were compared.Results RVEF, SPAP, and BNP, and FC significantly improved in both treatment groups (p<0.05 for all). Sa (p<0.01), TAPSE (p<0.01), LVEF (p<0.01), and Ea / Aa (p<0.05) improved only in the levosimendan group. The pre- and post-treatment Δs for RVEF, LVEF, SPAP, Sa, TAPSE, FC, and Ea / Aa were higher in the levosimendan group than in the dobutamine group (p<0.05 for all).Conclusion Compared to dobutamine, levosimendan produced greater improvement in right ventricular systolic and diastolic function in patients with biventricular heart failure and in need of inotropic therapy support.

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“…HF comprises heart dysfunction accompanied by clinical symptoms. HF has become a major cause of mortality and morbidity 1 , 2 . Compared to the left heart, the right heart has a limited influence on systemic diseases; thus, clinicians and researchers have not been very concerned about this facet in the past.…”

Section: Introductionmentioning

confidence: 99%

The effect of levosimendan on right ventricular function in patients with heart dysfunction: a systematic review and meta-analysis

Wei

Zhang

et al. 2021

Sci Rep

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Levosimendan exerts positive inotropic and vasodilatory effects. Currently, its effects on right heart function remain uncertain. This systematic review and meta-analysis is intended to illustrate the impacts of levosimendan on systolic function of the right heart in patients with heart dysfunction. We systematically searched electronic databases (PubMed, the Cochrane Library, Embase and Web of Science) up to November 30, 2020, and filtered eligible studies that reported the impacts of levosimendan on right heart function. Of these, only studies whose patients suffered from heart dysfunction or pulmonary hypertension were included. Additionally, patients were divided into two groups (given levosimendan or not) in the initial research. Then, RevMan5.3 was used to conduct further analysis. A total of 8 studies comprising 390 patients were included. The results showed that after 24 h of levosimendan, patients’ right ventricular fractional area change [3.17, 95% CI (2.03, 4.32), P < 0.00001], tricuspid annular plane systolic excursion [1.26, 95% CI (0.35, 2.16), P = 0.007] and tricuspid annular peak systolic velocity [0.86, 95% CI (0.41, 1.32), P = 0.0002] were significantly increased compared to the control group. And there is an increasing trend of cardiac output in levosimendan group [1.06, 95% CI (− 0.16, 2.29), P = 0.09 ] .Furthermore, patients’ systolic pulmonary arterial pressure [− 5.57, 95% CI (− 7.60, − 3.54), P < 0.00001] and mean pulmonary arterial pressure [− 1.01, 95% CI (− 1.64, − 0.37), P = 0.002] were both significantly decreased, whereas changes in pulmonary vascular resistance [− 55.88, 95% CI (− 206.57, 94.82), P = 0.47] were not significant. Our study shows that in patients with heart dysfunction, levosimendan improves systolic function of the right heart and decreases the pressure of the pulmonary artery.

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Preoperative Levosimendan. A New Way for Organoprotection

Cited by 7 publications

References 0 publications

Cardiac, renal, and neurological benefits of preoperative levosimendan administration in patients with right ventricular dysfunction and pulmonary hypertension undergoing cardiac surgery: evaluation with two biomarkers neutrophil gelatinase-associated lipocalin and neuronal enolase

Cardiac, renal, and neurological benefits of preoperative levosimendan administration in patients with right ventricular dysfunction and pulmonary hypertension undergoing cardiac surgery: evaluation with two biomarkers neutrophil gelatinase-associated lipocalin and neuronal enolase

Comparative assessment of the effects of dobutamine and levosimendan on right ventricular ejection fraction in patients with biventricular heart failure

The effect of levosimendan on right ventricular function in patients with heart dysfunction: a systematic review and meta-analysis

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