PURPOSE: Levosimendan is a calcium sensitizer that increases cardiac contractility without increasing intracellular calcium concentration. In acute decompensated heart failure (ADHF), levosimendan increases cardiac output (CO), but in cardiogenic and septic shock its effects are largely unknown. We hypothesized that levosimendan increases CO and decreases serum lactate levels similarly among patients with ADHF (group A), cardiogenic (group C), and septic shock (group S).
METHODS: A prospective observational study was performed on 60 consecutive patients; 20 in each group. Levosimendan 0.05 μg/kg/min IV was started in all patients, without a bolus, and was increased by 0.05 μg/kg/min every 30 min to a maximum of 0.2 μg/kg/min IV, at which time levosimendan infusion was continued for 24h. Thermodilution CO and central venous saturation (ScvO2) were measured at baseline and q 4h thereafter for 48h. Arterial serum lactate was measured q 6h for 48h. Hypotension [mean arterial pressure (MAP) < 65 mmHg] was treated with norepinephrine (NE), titrated to a MAP ≥ 65 mmHg. Repeated measures ANOVA and Chi square tests were used for analyzing continuous data and proportions, respectively. Data presented as mean±SD, and signficance was defined as p < 0.05.
RESULTS: APACHE II scores were 15±7, 18±7, and 22±7 (p = 0.01) for groups A, C, and S, respectively. CO increased within each group (p = 0.01) but there were no differences in CO between the study groups (p = 0.58). ScvO2 did not change significantly within and between groups. Serum lactate decreased similarly in all groups (p = 0.003). Group A received less NE than did the other groups (p < 0.05). ICU mortality was 15%, 55%, and 45% in groups A, C, and S, respectively.
CONCLUSION: Levosimendan increased CO and decreased lactate levels similarly among patients with ADHF, cardiogenic, and septic shock. It did not appear to affect ScvO2.
CLINICAL IMPLICATIONS: Levosimendan could be used to improve CO, as an alternative to dobutamine, in patients with cardiogenic or septic shock.
DISCLOSURE: Jamal Alhashemi, No Financial Disclosure Information; No Product/Research Disclosure Information