Effects of Levosimendan on Systemic Perfusion in Patients with Low Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Score: Experience from a Single Center in Taiwan

Overview

Journal Acta Cardiol Sin

Date 2021 Sep 29

PMID 34584384

Citations 1

Authors

Ying-Hsiang Wang

Jia-Lin Chen

Chien-Sung Tsai

Yi-Ting Tsai

Chih-Yuan Lin

Hong-Yan Ke

Po-Shun Hsu

Affiliations

Soon will be listed here.

Abstract

Background: Patients with cardiogenic shock have a high risk of mortality. Intravenous levosimendan can provide pharmacologic inotrope support.

Objectives: We aimed to investigate the effect of levosimendan in patients with extremely severe cardiogenic shock and low Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) score with or without mechanical circulatory support.

Methods: From January 2017 to May 2019, 24 patients with INTERMACS 1-4 were enrolled in this retrospective study. All patients had systemic malperfusion and were treated with levosimendan. Biochemistry data related to systemic perfusion were recorded and compared before and at 24 and 72 hours after levosimendan administration. Echocardiography and Kansas City Cardiomyopathy Questionnaire (KCCQ) were completed 2 months later to assess left ventricular ejection fraction (LVEF) and quality of life (QoL), respectively.

Results: Arterial pressure and heart rate did not significantly differ before and after levosimendan administration. Atrial fibrillation and ventricular premature complex increased without significance. The dose of inotropes could be significantly tapered down. There were no significant differences in blood urea nitrogen, creatinine, and lactate levels. Urine output significantly increased (p = 0.018), and liver-related enzymes improved but without significance. B-type natriuretic peptide significantly decreased (p = 0.007) at 24 hours after levosimendan administration. Echocardiography showed significantly improved LVEF 2 months later (22.43 ± 8.13% to 35.87 ± 13.4%, p = 0.001). KCCQ showed significantly improved physical activity and greater relief of symptoms (p = 0.003). The survival-to-discharge rate was 75%.

Conclusions: We observed a decrease in B-type natriuretic peptide, better urine output, and alleviated hepatic injury in the levosimendan group. Most patients who survived without transplantation had significantly improved LVEF and better QoL after levosimendan administration.

Citing Articles

Levosimendan in intensive care and emergency medicine: literature update and expert recommendations for optimal efficacy and safety.

Girardis M, Bettex D, Bojan M, Demponeras C, Fruhwald S, Gal J J Anesth Analg Crit Care. 2023; 2(1):4.

PMID: 37386589 PMC: 8785009. DOI: 10.1186/s44158-021-00030-7.

References

Mochizuki M, Yano M, Oda T, Tateishi H, Kobayashi S, Yamamoto T . Scavenging free radicals by low-dose carvedilol prevents redox-dependent Ca2+ leak via stabilization of ryanodine receptor in heart failure. J Am Coll Cardiol. 2007; 49(16):1722-32. DOI: 10.1016/j.jacc.2007.01.064. View

Green C, Porter C, Bresnahan D, Spertus J . Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: a new health status measure for heart failure. J Am Coll Cardiol. 2000; 35(5):1245-55. DOI: 10.1016/s0735-1097(00)00531-3. View

Papp Z, Edes I, Fruhwald S, De Hert S, Salmenpera M, Leppikangas H . Levosimendan: molecular mechanisms and clinical implications: consensus of experts on the mechanisms of action of levosimendan. Int J Cardiol. 2011; 159(2):82-7. DOI: 10.1016/j.ijcard.2011.07.022. View

Nieminen M, Akkila J, Hasenfuss G, Kleber F, Lehtonen L, Mitrovic V . Hemodynamic and neurohumoral effects of continuous infusion of levosimendan in patients with congestive heart failure. J Am Coll Cardiol. 2000; 36(6):1903-12. DOI: 10.1016/s0735-1097(00)00961-x. View

Chang C, Chen H, Caffrey J, Hsu J, Lin J, Lai M . Survival Analysis After Extracorporeal Membrane Oxygenation in Critically Ill Adults: A Nationwide Cohort Study. Circulation. 2016; 133(24):2423-33. DOI: 10.1161/CIRCULATIONAHA.115.019143. View

Sorsa T, Heikkinen S, Abbott M, Abusamhadneh E, Laakso T, Tilgmann C . Binding of levosimendan, a calcium sensitizer, to cardiac troponin C. J Biol Chem. 2000; 276(12):9337-43. DOI: 10.1074/jbc.M007484200. View

Altenberger J, Parissis J, Costard-Jaeckle A, Winter A, Ebner C, Karavidas A . Efficacy and safety of the pulsed infusions of levosimendan in outpatients with advanced heart failure (LevoRep) study: a multicentre randomized trial. Eur J Heart Fail. 2014; 16(8):898-906. DOI: 10.1002/ejhf.118. View

York M, Gupta D, Reynolds C, Farber-Eger E, Wells Q, Bachmann K . B-Type Natriuretic Peptide Levels and Mortality in Patients With and Without Heart Failure. J Am Coll Cardiol. 2018; 71(19):2079-2088. PMC: 5951190. DOI: 10.1016/j.jacc.2018.02.071. View

Francis G, Bartos J, Adatya S . Inotropes. J Am Coll Cardiol. 2014; 63(20):2069-2078. DOI: 10.1016/j.jacc.2014.01.016. View

10.

Theiss H, Grabmaier U, Kreissl N, Hagl C, Steinbeck G, Sodian R . Preconditioning with levosimendan before implantation of left ventricular assist devices. Artif Organs. 2013; 38(3):231-4. DOI: 10.1111/aor.12150. View

11.

Slaughter M, Rogers J, Milano C, Russell S, Conte J, Feldman D . Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med. 2009; 361(23):2241-51. DOI: 10.1056/NEJMoa0909938. View

12.

Papp Z, Agostoni P, Alvarez J, Bettex D, Bouchez S, Brito D . Levosimendan Efficacy and Safety: 20 years of SIMDAX in Clinical Use. Card Fail Rev. 2020; 6:e19. PMC: 7374352. DOI: 10.15420/cfr.2020.03. View

13.

Guglin M, Kaufman M . Inotropes do not increase mortality in advanced heart failure. Int J Gen Med. 2014; 7:237-51. PMC: 4038527. DOI: 10.2147/IJGM.S62549. View

14.

Pathak A, Lebrin M, Vaccaro A, Senard J, Despas F . Pharmacology of levosimendan: inotropic, vasodilatory and cardioprotective effects. J Clin Pharm Ther. 2013; 38(5):341-9. DOI: 10.1111/jcpt.12067. View

15.

John R, Long J, Massey H, Griffith B, Sun B, Tector A . Outcomes of a multicenter trial of the Levitronix CentriMag ventricular assist system for short-term circulatory support. J Thorac Cardiovasc Surg. 2010; 141(4):932-9. DOI: 10.1016/j.jtcvs.2010.03.046. View

16.

Grossini E, Molinari C, Pollesello P, Bellomo G, Valente G, Mary D . Levosimendan protection against kidney ischemia/reperfusion injuries in anesthetized pigs. J Pharmacol Exp Ther. 2012; 342(2):376-88. DOI: 10.1124/jpet.112.193961. View

17.

Fang J . Rise of the machines--left ventricular assist devices as permanent therapy for advanced heart failure. N Engl J Med. 2009; 361(23):2282-5. DOI: 10.1056/NEJMe0910394. View

18.

Altenberger J, Gustafsson F, Harjola V, Karason K, Kindgen-Milles D, Kivikko M . Levosimendan in Acute and Advanced Heart Failure: An Appraisal of the Clinical Database and Evaluation of Its Therapeutic Applications. J Cardiovasc Pharmacol. 2017; 71(3):129-136. PMC: 5862004. DOI: 10.1097/FJC.0000000000000533. View

19.

Mavrogeni S, Giamouzis G, Papadopoulou E, Thomopoulou S, Dritsas A, Athanasopoulos G . A 6-month follow-up of intermittent levosimendan administration effect on systolic function, specific activity questionnaire, and arrhythmia in advanced heart failure. J Card Fail. 2007; 13(7):556-9. DOI: 10.1016/j.cardfail.2007.04.004. View

20.

Fang M, Cao H, Wang Z . Levosimendan in patients with cardiogenic shock complicating myocardial infarction: A meta-analysis. Med Intensiva (Engl Ed). 2017; 42(7):409-415. DOI: 10.1016/j.medin.2017.08.009. View