Safety and Feasibility of Levosimendan Administration in Takotsubo Cardiomyopathy: A Case Series

Abstract

SUMMARYBackground: Levosimendan is a noncatecholamine inotrope that does not increase oxygen consumption, utilized for the treatment for acute heart failure with left ventricular (LV) systolic dysfunction. Its use in takotsubo cardiomyopathy (TTC), a disease that contraindicates the use of catecholamine inotropes, is not well known. Methods: We prospectively analyzed 13 consecutive patients with TTC, low ejection fraction (EF) (<35%), and additional Mayo Clinic risk factors who were treated with i.v. infusion of levosimendan. Clinical course of patients, electrocardiogram presentation, LV function, and adverse events at follow-up were recorded. Results: All patients showed an impaired LV function (LVEF at admission 28 AE 5%), which significantly improved at discharge (51 AE 8%, P < 0.001). Mean hospital stay was 10 AE 4 days. Troponin levels at admission were directly related to length of hospitalization (r = 0.6, P < 0.001). Male gender (relative risk (RR) 1.85, P < 0.05), physical stress (RR 1.90, P < 0.05), ST elevation at ECG (RR 1.87, P < 0.05), and absence of chest pain (RR 2.23, P < 0.01) were found to be the predictors of longer hospital stay. Only 15% of subjects had adverse events during hospital stay; two patients incurred noncardiovascular death at follow-up. Age was the only predictor of adverse event at follow-up (RR 2.13, P < 0.05). Conclusions: The use of levosimendan may be safe and feasible in patients with TTC. Randomized studies are warranted to further confirm these preliminary results.

Takotsubo Cardiomyopathy in Traumatic Brain Injury: A Case Report

“…Overall we identified 14 published articles involving 17 TBI patients with TC [8][9][10][11][12][13][14][15][16][17][18][19][20][21]. Among them, 14 were adults, all except two patients presented with loss of consciousness requiring endotracheal intubation and mechanical ventilation for airway protection.…”

“…It has been widely described after severe brain insult like subarachnoid hemorrhage (SAH, 1.2-28 %) [4][5][6]; however, it rarely occurs in patients with intracerebral hemorrhage, ischemic stroke, and traumatic brain injury (TBI) [7]. Here, we report a case of moderate TBI presenting with severe TC and provide a comprehensive review of all reported TBI cases [8][9][10][11][12][13][14][15][16][17][18][19][20].…”

Can Levosimendan Be a Treatment Option in Subarachnoid Hemorrhage?

“…Takotsubo kardiyomiyopatisi, belirgin koroner arter stenozu olmamasına rağmen sol ventrikül duvar hareket bozukluğu, EKG değişiklikleri ve miyokard enzimlerinin salınımı ile karakterize bir sendromdur (11). Genellikle duygusal ya da fiziksel stresör bir tetikleyici sonrası ortaya çıkmaktadır (12). Katekolaminler ve stres ilişkili nöropeptidlerin anormal plazma düzeyleri hastaların sadece %75'inde saptanabilir olmasına rağmen kolaylaştırıcı ana faktör olarak düşünülmektedir (12).…”

“…Genellikle duygusal ya da fiziksel stresör bir tetikleyici sonrası ortaya çıkmaktadır (12). Katekolaminler ve stres ilişkili nöropeptidlerin anormal plazma düzeyleri hastaların sadece %75'inde saptanabilir olmasına rağmen kolaylaştırıcı ana faktör olarak düşünülmektedir (12). Takotsubo kardiyomiyopatisi tipik olarak apikal akinezi ve bazal segment fonksiyonunun korunması şeklinde tanımlanmaktadır.…”

Levosimendan: New hope therapy for takotsubo syndrome

“…First evidence for the use of levosimendan comes from 4 case reports who developed TS-related cardiogenic shock [11][12][13] or sepsisassociated TS [14]. Further support demonstrating the safety, feasibility and efficacy of levosimendan has been reported in a first prospective pilot study which included 13 consecutive patients with TS and severe ventricle dysfunction [15]. A continuous infusion of levosimendan at a dose of 0.1 µg/kg/min within the first 24-h of hospital admission improved LV ejection fraction (28 ± 5% at admission vs. 51 ± 8% at discharge, p < 0.001).…”