Key result
Levosimendan improved external efficiency by 33% and decreased early reperfusion arrhythmias (7% vs 25%, P < 0.05) in isolated rabbit hearts, while providing energy-neutral inotropy in heart failure.
Why the study?
While levosimendan is known to improve ventricular function, induce vasodilation, and induce myocardial preconditioning, its effects on external efficiency and reperfusion arrhythmias required determination.
Does levosimendan improve hemodynamic function, organ perfusion, and clinical outcomes compared with placebo or conventional adrenergic inotropes in acute and advanced heart failure?
Does levosimendan improve hemodynamic function, organ perfusion, and clinical outcomes compared with placebo or conventional adrenergic inotropes in acute and advanced heart failure?
Levosimendan provides energy-neutral inotropy, vasodilation, cardioprotection, and renal afferent arteriolar dilation, making it a valuable inodilator option in low-output acute heart failure, cardiogenic shock, cardiorenal syndrome, and advanced heart failure.
BACKGROUND: Levosimendan improves ventricular function, induces vasodilation and induces myocardial preconditioning. We determined the external efficiency and assessed the effects on arrhythmias. METHODS: In isolated, blood-perfused rabbit hearts, levosimendan (0.75 micromol) or placebo was administered, while hemodynamics were recorded. After no-flow ischemia and reperfusion, data were recorded again. RESULTS: Placebo in normoxic hearts did not affect measurements, while levosimendan increased heart rate (+ 18 %) and improved coronary output (+ 52 %), stroke volume (+ 28 %), maximal left ventricular pressure (+ 30 %), maximal rate of pressure increase (+ 36 %), work (+ 68 %), minimal rate of pressure increase (+ 53 %), coronary blood flow (+ 41 %), coronary resistance (- 19 %) and external efficiency (33 %; P < 0.05). During reperfusion, hemodynamics in the levosimendan group were significantly better preserved compared with the placebo group. Early reperfusion arrhythmias were decreased (levosimendan group: 7 +/- 3 % vs. placebo group: 25 +/- 17 %; P < 0.05). CONCLUSIONS: Levosimendan does not impair diastole, dilates coronary vessels, induces pharmacological preconditioning, improves external efficiency and exerts antiarrhythmic properties during reperfusion. As this drug protects the heart from reperfusion injury, it seems well suited for treating dysfunctional hearts after cardiac surgery.
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Meyer et al. (2008) conducted a review in Acute heart failure, advanced heart failure, cardiogenic shock, and cardiorenal syndrome. Levosimendan vs. Placebo or adrenergic inotropes (such as dobutamine) was evaluated on External efficiency and early reperfusion arrhythmias (preclinical abstract) / Haemodynamic function and survival in AHF and AdHF (clinical review) (p=< 0.05). Levosimendan improved external efficiency by 33% and decreased early reperfusion arrhythmias (7% vs 25%, P < 0.05) in isolated rabbit hearts, while providing energy-neutral inotropy in heart failure.
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