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At least 307 records · Page 17Linked to original sources
PubMed2005

[Cardiogenic shock-- new therapeutic strategies].

BACKGROUND: Cardiogenic shock is a condition associated with high mortality. The evidence base for choice of treatment is insufficient, but new therapeutic options and new understanding have lead to some improvement in the prognosis. A new class of heart failure medication is now approved in Norway (calcium sensitizers). METHODS: We present a case history that illustrates new options in the treatment of cardiogenic shock complicating acute myocardial infarction. We have searched available literature and give a review of the treatment of cardiogenic shock with special emphasis on the role of inotropic drug therapy. RESULTS AND INTERPRETATION: A 46-year-old man with cardiogenic shock complicating myocardial infarction because of occlusion of the left-main coronary artery was treated with acute revascularization, intra-aortic balloon counterpulsation (IABP) and levosimendan. Early revascularization is a key factor in the treatment of cardiogenic shock; rapid transfer of patients to a revascularization centre is recommended. IABP should be considered after successful revascularization because of post-ischaemic dysfunction that persists despite restoration of epicardial blood flow. Beta-adrenergic stimulation of the heart should, if possible, be avoided, because of increased myocardial oxygen requirement, calcium overload of the cardiomyocytes, and increased mortality. Drug therapy using calcium sensitizers is promising, but more controlled clinical trials are needed.

Cardiotonic Agents↗
PubMed2005

[Levosimendan, a revolution in the world of inotropic agents?].

Levosimendan is the first available drug of a new class of agents called calcium sensitizers. It increases cardiac contractility without increasing myocardial oxygen consumption. This new molecule has no proarrhythmic effects and has anti-ischemic properties. Levosimendan is infused over a 24-hour period and its hemodynamic effects, similar or superior to those of catecholamines, persist during one week. In a selected group of advanced heart failure patients levosimendan was associated with a mortality reduction at 14 days and at 6 months in comparison with dobutamine. In spite of its cost, this new inotropic agent appears very promising and it is expected that it will be widely used.

Anti-Arrhythmia Agents↗
PubMedDate not supplied

[Use of levosimendan after cardiac arrest by ventricular fibrillation: a case report].

We describe the case of a patient admitted in intensive care, after cardiac arrest by ventricular fibrillation treated by electrical defibrillation, that showed a serious deficit of the cardiac index and increase of the systemic vascular resistances. The patient was treated by levosimendan (Simdax): a starter dose of 12 microg/Kg in ten minutes and then a continuous perfusion of 0.1 microg/Kg/min. for 24 hours. He had a continuous amelioration of the clinical conditions and of the hemodynamics parameters. In the fifth day the patient was transferred to the Cardiology department and after 20 days he was discharged from hospital.

Anti-Arrhythmia Agents↗
PubMed2005

[The novelty in the treatment of heart failure].

Heart failure is a very common clinical pathology. The treatment of heart failure is expensive; therefore, it is a large burden on the health care system in the world. Despite many recent advances in heart failure therapy, the prognosis remains poor. Levosimendan is a novel inotropic vasodilator agent. This drug induces enhanced contractility mainly via its calcium sensitizing actions. Levosimendan does not increase myocardial oxygen demand and also reduces significantly systemic vascular resistance, pulmonary artery pressure, and pulmonary vascular resistance. It causes venous, arterial, and coronary vasodilation. The drug is not proarrhythmic, has anti-ischemic and anti-stunning effects. It is well-tolerated drug for the treatment of cardiac failure. This review article discusses mechanism of action of levosimendan, its pharmacokinetics and metabolism, hemodynamic studies with this drug, effects on morbidity and mortality, therapeutic indication for its use, contraindications, special warnings and precautions for use, interactions with others medical products, undesirable effects of levosimendan.

Adolescent↗
PubMedDate not supplied

[Hemodynamic effects of levosimendan following cardiac surgery].

The hemodynamic effect of levosimendan was compared to that of dobutamine in a trial enrolling 30 adults undergoing scheduled cardiac surgery with cardiopulmonary bypass. Fifteen patients were randomly assigned to receive levosimendan in a single dose of 18 microg x kg(-1) followed in 15 to 20 minutes by start of infusion at a rate of 0.2 microg x kg(-1) min(-1) for 24 hours (levosimendan group). Another 15 randomized patients received dobutamine infused at a rate of 7.5 microg x kg(-1) min(-1). Hemodynamic parameters were measured before starting infusion of the drug and after 24 hours of treatment. Changes in the main hemodynamic parameters were as follows. In the levosimendan group heart rate (beats/min) was 87.15 (SD 10.22) at baseline and 87.91 (6.00) at 24 hours; mean arterial pressure (mm Hg) was 83.96 (10.57) at baseline and 86.41 (13.29) after 24 hours; cardiac index (L/min/m2) was 2.21 (0.23) at baseline and 2.53 (0.35) at 24 hours; systemic vascular resistance (dyn/sec(-1)/cm(-5)) was 1436.74 (311.48) at baseline and 1378.35 (320.68) at 24 hours. In the dobutamine group heart rate (beats/min) was 84.28 (2.18) at baseline and 96.02 (9.10) after 24 hours; mean arterial pressure (mm Hg) was 83.59 (9.05) at baseline and 74.29 (6.33) at 24 hours; cardiac index (L/min/m2) was 2.16 (0.28) at baseline and) 3.02 (0.34) at 24 hours; systemic vascular resistance (dyn/sec(-1)/cm(-5)) was 1578.93 (334.88) at baseline and 1136.68 (158.60) at 24 hours. We found that mean arterial pressure and both systemic and pulmonary vascular resistance decreased significantly in the levosimendan group (P < 0.05), but not in the dobutamine group. On the other hand, both heart rate and cardiac index increased in the levosimendan group only (P < 0.05). We conclude that levosimendan improves hemodynamic stability in patients who have undergone cardiac surgery and that it is a good alternative for treating postoperative low cardiac output syndrome.

Adult↗
PubMed2005

Levosimendan: dual mechanisms for acute heart failure...and beyond?

Levosimendan is a novel compound recently approved for the management of acute heart failure in Sweden and several European countries. Levosimendan exerts dual mechanisms of action associated with dose-dependent increases in cardiac output and decreases in pulmonary capillary wedge pressures. A positive inotropic effect is achieved through calcium sensitization, an effect of levosimendan binding to troponin C in a calcium-dependent manner. This mode of enhanced contractile force generation is achieved without an increase in myocardial oxygen consumption, intracellular calcium concentrations, or an adverse effect on diastolic function. The vasodilatory effect observed in cardiac, pulmonary and systemic vasculature occurs as a result of K-ATP channel activation, a mechanism which may also confer anti-ischemic properties. It remains unclear whether calcium sensitization or K-ATP channel activation is of greater clinical significance. Clinical studies utilizing fixed-dose infusions of 6 to 24 h in patients with left ventricular systolic dysfunction demonstrate greater safety and hemodynamic efficacy than placebo or dobutamine. This has translated into improved comparative survival at 31 days and potentially 180 days. Two additional prospective, outcome studies are being completed to confirm the beneficial effect on morbidity and mortality. Hypo-tension and decreased hematologic indices are the most common adverse effects requiring monitoring. No relevant drug interactions have been noted with chronic oral heart failure medications. Levosimendan's unique safety and efficacy profile suggests it is a rationale alternative to conventional inotropes, and potentially a useful first line agent for management of acute decompensated heart failure. Its role in other clinical scenarios, such as for cardiac surgery, diastolic dysfunction and outpatient infusion therapy, continues to evolve.

Acute Disease↗
PubMed2005

Levosimendan as a new strategy during off-pump coronary artery bypass grafting: double-blind randomized placebo-controlled trial.

AIM: To determine if levosimendan could improve cardiac performance during off-pump coronary artery bypass grafting in patients with normal preoperative left ventricular function. METHODS: Twenty-four patients included in this double-blind randomized controlled trial received either placebo (n=12) or 12 microg/kg loading dose of levosimendan (n=12) during a period of 15 minutes before the surgery. The heart rate, cardiac index, stroke volume index, and left ventricular ejection fraction were measured before and 10 and 60 minutes after the drug administration. RESULTS: The baseline measurements of hemodynamic parameters did not differ between the groups. Heart rate was not significantly different between the placebo and levosimendan group. Compared with placebo group, cardiac index and left ventricular ejection fraction were significantly higher 10 and 60 minutes (p=0.018 for all) after administration of levosimendan. After 60 minutes, the cardiac index increased from the baseline value of 2.18 to 2.84 L/min/m2. Left ventricular ejection fraction increased by 14% after 10 minutes, and by 10% after 60 minutes. Stroke volume index was significantly higher at 10 minutes (p=0.018), but not at 60 minutes (p=0.063) after the administration of levosimendan. CONCLUSION: Administration of 12 microg/kg of levosimendan enhances the left ventricular performance and offers a promising therapeutic option during off-pump coronary artery bypass grafting in patients with good preoperative left ventricular function.

Aged↗
PubMedDate not supplied

[Levosimendan in patients with acute cardiac failure].

OBJECTIVE: To assess levosimendan efficacy in acute cardiac failure. METHODS: We included 25 patients with acute cardiac failure and partial conventional therapy response defined as persistence of low cardiac output with inotropic support. We started levosimendan at loading dose and continuous infusion for 24 hours, recording hemodynamic data, as well as clinical variables. RESULTS: All patients showed clinical and hemodynamic improvement. Pulmonary wedge capillary pressure (PWCP) decreased from 18 cmH2O (11-30 cmH2O) to 14 cmH2O (8-15 cmH2O) at 12 hours (p = 0.3) and to 13 cmH2O (8-12 cmH2O) at the end of the infusion period (p = 0.2). Cardiac index increased from 2.1 L/min/m2 (1.8-3.5 L/ min/m2) to 2.86 L/min/m2 (2-4.3 L/min/m2) at 12 hours (p = 0.03) and to 3.08 L/min/m2 at the end of the infusion period (p = 0.02). Tachycardia higher than 120 bpm was present in six patients. No major hypotensive events were present. Mortality to the present is of eight patients. CONCLUSION: Levosimendan infusion improved hemodynamics and clinical variables in acute cardiac failure with few side effects in this small series of patients.

Acute Disease↗
PubMedDate not supplied

[Levosimendan: a new strategy in the treatment of heart failure].

Congestive heart failure is a long standing health issue. Traditionally, heart failure has been treated with a wide array of drugs such as diuretics, digitalis, catecholamine and non catecholamine inotropics, although treatment with these drugs bears adverse effects, such as the generation of arrhythmia and even death. A new class of drugs has recently exerted a positive impact on the treatment of patients with heart failure; these are the calcium sensitizers that enhance myocardial contractility without increasing cytosolic calcium. Levosimendan is a calcium sensitizer that, besides increasing contractility, has a vasodilating effect due to the activation of K(ATP) channels, being both mechanisms responsible for an advantageous therapeutic option. Different studies have proven the efficiency and safety profile of the drug on various scenarios and populations; thereby considering levosimendan a real and safe alternative treatment for patients with acute or chronic ventricular failure that need intravenous pharmacological support.

Heart Failure↗
PubMed2005

[Successful use of levosimendan in a patient with cardiogenic shock complicating acute myocardial infarction].

Levosimendan is a new inodilator that improves cardiac contractility by sensitizing troponin C to calcium. This drug has proved to be effective in treating advanced congestive heart failure but has not been evaluated in cardiogenic shock. We present the case of a 54-year-old male patient treated successfully with levosimendan for cardiogenic shock following acute myocardial infarction. Treatment with dobulamine. revascularisation and itra-aortic balloon conterpulsation had first failed to improve his hemodynamic variables. Levosimendan induced a steady decline of increased pulmonary capillary wedge pressure, followed by an increase in cardiac index and mixed venous oxygen saturation. Left ventricular ejection fraction improved from 25% to 47%. Infusion of levosimendan can be used in cardiogenic shock without side effects and to improve hemodynamics and left ventricular function.

Cardiotonic Agents↗
PubMed2006

[Levosimendan--an alternative to conventional inotropic treatment of patients with acute heart failure?].

In acute heart failure the myocardial function is acutely reduced and the oxygenation of the tissues becomes inadequate. Traditional inotropic drugs improve the haemodynamics and give symptomatic relief, but the evidence of injurious effects on morbidity and mortality restricts their use. The need for new inotropic drugs which can also reduce morbidity and mortality is for that reason obvious. Levosimendan is such a new drug in a new class (Ca2+ sensitizers) of positive inotropic drugs with favourable effects compared to existing treatment possibilities.

Cardiotonic Agents↗
PubMed2006

[Medical and ventilatory treatment of acute heart failure].

BACKGROUND: Traditional medical treatment of acute heart failure has remained unchanged for many years. It has been based on oxygen supplementation and mechanical ventilatory support as well as the administration of morphine, diuretics, nitrates and inotropic agents. In 2005 the European Society of Cardiology published new guidelines on diagnosis and treatment. Also, new therapies have been introduced recently, giving rise to changes in therapeutic concepts. MATERIAL AND METHOD: The article is based on these new guidelines and recent studies selected from the literature. RESULTS: Mechanical ventilatory support reduces the number of patients who require endotracheal intubation. Nitrates in higher dosages than employed today appear to be beneficial to patients with pulmonary congestion, probably because of the pronounced afterload reducing effect. Nesiritide has shown better haemodynamic effects than common nitrate dosages in patients with congestive heart failure. Tezosentan was tested in the biggest trial ever which, however, was terminated prematurely, because of futility with regard to the endpoints dyspnoea and death. Dobutamine and milrinone are associated with increased mortality in patients with pronounced chronic and acute congestive heart failure. Levosimendan has shown lower mortality compared to dobutamine in patients with acute congestive heart failure. INTERPRETATION: New concepts have finally emerged, including the application of old drugs such as nitrates in new (i.e., higher) dosages, as well as the novel compound levosimendan, and hypoperfused organs without severe hypotension. The new European Society of Cardiology classification provides a valuable and long-awaited guideline to diagnosis and treatment.

Acute Disease↗
PubMedDate not supplied

The effects of Levosimendan on global haemodynamics in patients with cardiogenic shock.

UNLABELLED: Levosimendan may improve the outcome of acute heart failure patients with preserved arterial blood pressure. However, the data on its use in critically ill patients are scarce. OBJECTIVES: The aim of this study was to assess the effects of levosimendan on global haemodynamics in patients with cardiogenic shock. MATERIALS AND METHODS: Fourteen adult patients in cardiogenic shock were studied prospectively. One patient died after 10 hours and was excluded from final analysis. Haemodynamic monitoring included arterial and pulmonary arterial thermodilution catheters. Before levosimendan administration, 12 patients required norepinephrine, 6 patients dobutamine and 4 patients intraaortic balloon pump. Levosimendan was given as a bolus (12 microg x kg(-1) x 10 min(-1)) followed by 24 hrs infusion (0.1 microg x kg(-1) x min(-1)). Baseline data had been collected before levosimendan administration. Following data sets were obtained after 1, 8, 16 and 24 hours. Positive haemodynamic response was defined as an increase of > or = 30% in cardiac output. RESULTS: Eleven patients met the criterion for the positive haemodynamic response. During levosimendan infusion systemic vascular resistance decreased (p<0.05) whereas cardiac output (p<0,001) and urine output increased (p<0.01). Mean arterial pressure and heart rate remained unchanged. No severe arrhythmias occurred and norepinephrine-dose did not change. Two patients were classified as non-responders. CONCLUSIONS: Our results suggest that levosimendan infusion given as adjunctive therapy in patients with cardiogenic shock may be safe with beneficial effects on global haemodynamics.

Adrenergic alpha-Agonists↗
PubMed2006

[Hemodynamic effects of levosimendan compared with dobutamine in patients with low cardiac output after cardiac surgery].

INTRODUCTION AND OBJECTIVES: Levosimendan is an inotropic agent that is effective in the treatment of heart failure. However, experience with levosimendan in patients with reduced cardiac output following cardiopulmonary bypass is limited. The objective of this study was to compare the short-term hemodynamic effects of levosimendan with those of dobutamine in managing low cardiac output after cardiac surgery. METHODS: Forty-one patients who had low cardiac output after cardiopulmonary bypass were randomly assigned to dobutamine (n=20), 24-hour infusion of 7.5 microg/kg per min, or levosimendan (n=21), at a loading dose of 12 microg/kg followed by 24-hour infusion of 0.2 microg/kg per min. The following parameters were determined during a 48-hour observation period: arterial, central venous, pulmonary arterial and pulmonary capillary wedge pressure, cardiac index, heart rate, stroke volume, and systemic and pulmonary vascular resistance. RESULTS: Although both dobutamine and levosimendan improved the cardiac index, the increase was significantly greater with levosimendan (2.4 [0.2] l/min per m2 vs 2.9 [0.3] l/min per m2, respectively, at 24 h; P<.05). Moreover, levosimendan significantly reduced systemic and pulmonary vascular resistance, and significantly decreased systemic arterial, pulmonary arterial, pulmonary capillary wedge, and central venous pressure. CONCLUSIONS: Both dobutamine and levosimendan are effective in managing postoperative low cardiac output. However, levosimendan induces non-specific systemic, venous and pulmonary vasodilation which can result in hypotension as a adverse event. In these patients, it is advisable to omit or reduce the loading dose.

Aged↗
PubMed2006

[Therapy of acute decompensated heart failure with levosimendan].

PURPOSE: To determine the short-term hemodynamic and clinical effects of levosimendan, a calcium-sensitizing agent, in patients with decompensated heart failure. PATIENTS AND METHODS: Seven patients with cardiogenic shock requiring catecholamines (two patients with acute myocardial infarction, two patients with decompensated hypertensive heart disease, one patient with low cardiac output with ischemic cardiomyopathy, two patients with dilated cardiomyopathy [ethyl-toxic, polymyositis] with a cardiac index < or = 2.5 ) 1 x min(-1) x m(-2) and a pulmonary wedge pressure > or = 15 mmHg received levosimendan with an initial loading dose of 12 microg/kg over 10 min followed by a continuous infusion of 0.1 microg/kg/min for 24 h. RESULTS: During levosimendan infusion an increase in cardiac index (30% after 6 h and 24 h), a decrease in heart rate (4% after 6 h and 10% after 24 h, respectively), and a decrease in systemic vascular resistance (27% after 6 h and 41% after 24 h, respectively) appeared. In combination with volume resuscitation the pulmonary capillary wedge pressure increased. Under therapy with levosimendan no relevant adverse events occurred; there was no increase in severe cardiac arrhythmias and QT interval duration. CONCLUSION: Levosimendan causes rapid improvement in hemodynamic function in patients with cardiogenic shock. These hemodynamic effects are not associated with relevant adverse events. Levosimendan may be of value in the short-term management of patients with cardiogenic shock.

Adult↗