The calcium sensitizer levosimendan improves the function of stunned myocardium after percutaneous transluminal coronary angioplasty in acute myocardial ischemia

Sonntag, Sabine; Sundberg, Stig; Lehtonen, Lasse; Kleber, Franz X.

doi:10.1016/j.jacc.2004.02.052

Cited by 168 publications

(122 citation statements)

References 30 publications

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“…Also, levosimendan was effective in detecting contractile reserve even in the proportion of patients with ischaemic LV dysfunction who had no clear evidence of contractile reserve with dobutamine. Our results are in keeping with a recent study which showed that a 10-minute infusion of 24 μg/kg of levosimendan induced a significant improvement of contractility in stunned myocardium measured 20 min after the end of the infusion [9]. A clinical implication from our trial is that revascularisation may be beneficial in some patients not responding to dobutamine, but our findings need confirmation in a larger study.…”

Section: Resultssupporting

confidence: 91%

Levosimendan allows detection of contractile reserve in patients with chronic ischaemic left ventricular dysfunction and non‐diagnostic dobutamine echocardiography

Cianfrocca

Pelliccia

Auriti

et al. 2007

European J of Heart Fail

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Background: Dobutamine echocardiography is commonly used to detect contractile reserve in ischaemic left ventricular (LV) systolic dysfunction, although its sensitivity and specificity are not optimal. We tested the hypothesis that echocardiography with levosimendan could identify contractile reserve in patients with a non-diagnostic dobutamine test. Methods: Twenty-two patients with LV ejection fraction b 40% and non-diagnostic dobutamine echocardiography underwent levosimendan challenge (24 μg/kg in 10 min) prior to coronary angioplasty or surgery. Results: Contractile reserve was identified by levosimendan in 10 patients (Gr. A) but was not seen in 12 patients (Gr. B). With levosimendan, LV ejection fraction increased and wall motion score index decreased significantly in Gr. A, but only slightly in Gr. B. Similarly, mean mitral annular plane excursion and peak systolic mitral annular motion velocity increased significantly in Gr. A only. Six months after revascularisation, contractile reserve was seen in 8/10 Gr. A patients but in only 2/12 Gr. B patients (80% vs 17%, p = 0.011). LV ejection fraction, wall motion score index, mean mitral annular plane excursion and peak systolic mitral annular motion velocity were significantly higher in Gr. A than in Gr. B. Conclusion: Levosimendan echocardiography can identify contractile reserve in a sizeable proportion of patients with chronic ischaemic LV dysfunction and a non-diagnostic dobutamine test.

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Section: Resultssupporting

confidence: 91%

Levosimendan allows detection of contractile reserve in patients with chronic ischaemic left ventricular dysfunction and non‐diagnostic dobutamine echocardiography

Cianfrocca

Pelliccia

Auriti

et al. 2007

European J of Heart Fail

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“…Besides these, levosimendan enhances coronary vasodilatation via the nitric oxide-dependent pathway, which inhibits phosphodiesterase-3 and contributes to the protection of the myocardium from ischemia by means of increasing the coronary blood flow (12,13). It has been demonstrated that levosimendan improves the myocardial systolic function in patients with a stunned myocardium who underwent percutaneous coronary intervention due to acute myocardial infarction (14).…”

Section: Discussionmentioning

confidence: 99%

Predictive Value of Fragmented QRS in Response to Levosimendan Therapy in Patients with Heart Failure

Erkal¹,

Bayar²,

Esin³

et al. 2017

Cyprus J Med Sci

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BACKGROUNDData on the effect on re-hospitalization are limited when levosimendan is added to conventional treatment. We aimed to investigate the role of fragmented QRS (f QRS) on the surface electrocardiogram in predicting the response to levosimendan therapy in patients with acute systolic heart failure. MATERIAL and METHODSPatients with a left ventricular ejection fraction of <35% were enrolled in this retrospective observational study. They were administered a levosimendan therapy for 24 h, and the number of re-admissions due to decompensated heart failure annually were recorded. Patients were divided two groups: group 1, 0-7 admissions per year and group 2, >7 admissions per year. RESULTSThere were 42 patients in group 1 and 24 in group 2. The presence of fragmented QRS was seen in 41% of the patients in group 1 and in 92% of the patients in group 2 (p<0.001). The presence of fragmented QRS during the hospitalization of patients treated with levosimendan was found to be an independent predictor of the admission of more than 7 patients in the multivariate analysis. CONCLUSIONThe presence of fragmented QRS during hospitalization may predict a lower response to levosimendan therapy in patients with decompensated heart failure.

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“…22 Moreover, a recent study demonstrated that levosimendan is safe in patients with acute coronary syndromes who underwent a percutaneous coronary intervention (PCI) and improves the function of stunned myocardium. 23 Safety, efficacy, and effects on mortality of levosimendan in patients with LV failure complicating AMI were investigated in the RUSSLAN study. 24 There were no significant differences among the treatment groups in the proportion of patients who experienced clinically important ischemia in this study.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Ischemic Side Effects of Levosimendan and Dobutamine with Integrated Backscatter Analysis

Duygu

Nalbantgil

Zoghi

et al. 2009

Clinical Cardiology

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Background: Levosimendan improves cardiac contractility without increasing oxygen consumption. However, its effects on ischemia were not supported with the utilization of a noninvasive parameter of myocardial characterization. Hypothesis: The changes observed in integrated backscatter (IBS) may be reflective of change in myocardial ischemia. In this study, the effect of levosimendan on ischemia detected by IBS was evaluated in patients with ischemic heart failure (HF). Methods: Patients who had LVEF <40% and NYHA III-IV symptoms of HF were included in this study. Patients were randomized to levosimendan (n = 21), or to dobutamine (n = 25) groups. The cyclic variation of integrated backscatter (CVIBS) was determined as the difference between the maximal and minimal values in a cardiac cycle, average of three consecutive beats. CVIBS was taken from the mid-anteroseptal, mid-inferior, and mid-posterolateral areas of the parasternal short axis images before the drug administration and at the end of the 24-hour infusion period. Results: Baseline characteristics and concomitant medications were similar in both groups. A significant reduction in CVIBS was detected in anteroseptal (7.6 ± 1.4 dB versus 5.9 ± 0.8 dB, p = 0.01), inferior wall (7.4 ± 0.8 dB versus 6.7 ± 1.5 dB, p = 0.03), and posterolateral wall (9.0 ± 1.2 dB versus 8.2 ± 0.6 dB, p = 0.04) after dobutamine administration, while no significant changes were observed in the levosimendan group in all walls. Conclusions: Unlike dobutamine, levosimendan may not induce myocardial ischemia as shown by CVIBS at commonly used dosages in the setting of decompensated HF without active ischemia.

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The calcium sensitizer levosimendan improves the function of stunned myocardium after percutaneous transluminal coronary angioplasty in acute myocardial ischemia

Abstract: Levosimendan improved the function of stunned myocardium without obvious impairment of diastolic function.

Cited by 168 publications

References 30 publications

Levosimendan allows detection of contractile reserve in patients with chronic ischaemic left ventricular dysfunction and non‐diagnostic dobutamine echocardiography

Levosimendan allows detection of contractile reserve in patients with chronic ischaemic left ventricular dysfunction and non‐diagnostic dobutamine echocardiography

Predictive Value of Fragmented QRS in Response to Levosimendan Therapy in Patients with Heart Failure

Comparison of Ischemic Side Effects of Levosimendan and Dobutamine with Integrated Backscatter Analysis

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