Key result
Levosimendan added to catecholamines improved cardiac index (from 1.5 to 2.1 l/min/m2, P=0.002) in patients with cardiogenic shock after acute MI, but only in those with high SVR.
Why the study?
Does levosimendan improve hemodynamics in patients with cardiogenic shock after acute myocardial infarction?
Observational (n=25)
Does levosimendan improve hemodynamics in patients with cardiogenic shock after acute myocardial infarction?
Levosimendan improves hemodynamics in cardiogenic shock complicating acute MI specifically in patients with high systemic vascular resistance.
Answers are grounded in this paper and cite their sources.
May support levosimendan consideration in high-SVR post-MI shock; case report leaves open need for randomized trials.
BACKGROUND: Levosimendan (LEVO), a new inodilator, improves hemodynamic function in patients with decompensated heart failure and preserved arterial blood pressure. Data on its use in patients with cardiogenic shock (CS) are scarce. The present study was undertaken to evaluate the hemodynamic effects of supplemental therapy with levosimendan (LEVO) in acute myocardial infarction (MI) and refractory cardiogenic shock (CS). METHODS: In 25 patients presenting in CS after acute MI, LEVO was administered for 24 h in doses ranging between 0.05 and 0.20 microg/kg/min, as tolerated, preceded by 6-microg/kg over 10 min, in addition to catecholamines. Hemodynamic measurements were made before and 24 h after initiation of the LEVO infusion. RESULTS: Hemodynamic improvement was limited to 13 patients with systemic vascular resistances (SVR) > or =18 W. LEVO increased the cardiac index from 1.5+/-0.3 l/min/m2 to 2.1+/-0.4 l/min/m2 (P = 0.002) and cardiac power from 0.462+/-0.164 W to 0.645+/-0.179 W (P = 0.022), and decreased SVR from 23+/-5 to 21+/-6.7 Wood units (P = 0.001) and pulmonary capillary wedge pressure from 24+/-9 mmHg to 16+/-11 mmHg (P = 0.059). No hemodynamic improvement was observed during LEVO administration in 12 patients with SVR < 18 W. CONCLUSION: The hemodynamic benefit conferred by LEVO added to catecholamines in patients with CS after acute MI was limited to patients with high SVR.
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Tsagalou et al. (2009) conducted an observational in Acute myocardial infarction complicated by cardiogenic shock (n=25). Levosimendan vs. Baseline was evaluated on Hemodynamic improvement (cardiac index, cardiac power, systemic vascular resistance, pulmonary capillary wedge pressure). Levosimendan added to catecholamines improved cardiac index (from 1.5 to 2.1 l/min/m2, P=0.002) in patients with cardiogenic shock after acute MI, but only in those with high SVR.
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