Key result
Levosimendan in severe cardiogenic shock is linked to a ~14% absolute LVEF increase and lower BNP.
Why the study?
Patients with cardiogenic shock face high mortality, and the effect of levosimendan in patients with extremely severe shock and low INTERMACS score with or without mechanical circulatory support needed investigation.
Does intravenous levosimendan improve systemic perfusion, cardiac function, and quality of life in patients with severe cardiogenic shock and low INTERMACS score?
Cohort (n=24)
No
Does intravenous levosimendan improve systemic perfusion, cardiac function, and quality of life in patients with severe cardiogenic shock and low INTERMACS score?
In patients with severe cardiogenic shock and low INTERMACS scores, levosimendan administration was associated with improved systemic perfusion, reduced BNP, and enhanced LVEF and quality of life among survivors.
Answers are grounded in this paper and cite their sources.
Levosimendan may improve cardiac function in severe cardiogenic shock; hypothesis-generating data that leaves open the need for RCTs before practice change.
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.
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Wang et al. (2021) conducted a cohort in Cardiogenic shock with low INTERMACS score (n=24). Levosimendan vs. Baseline (before administration) was evaluated on Systemic perfusion parameters, left ventricular ejection fraction, and quality of life. Levosimendan administration in severe cardiogenic shock significantly improved left ventricular ejection fraction (22.4% to 35.9%, p=0.001) and decreased B-type natriuretic peptide (p=0.007).
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