Haemodynamic effects of levosimendan in advanced but stable chronic heart failure

ESC Heart Fail. 2018 Jun;5(3):302-308. doi: 10.1002/ehf2.12272. Epub 2018 Feb 22.

Abstract

Aims: Levosimendan improves haemodynamics in acute decompensated heart failure (HF). However, it is increasingly used for repetitive or intermittent infusions in advanced but stable chronic HF, without clear indication, selection criteria, or effect. We tested the hypotheses that (1) levosimendan improves haemodynamics in stable chronic HF and (2) that the response is dependent on baseline clinical and haemodynamic factors.

Methods and results: Twenty-three patients [median age 56 (49-64) years, four (17%) women] with stable New York Heart Association (NYHA) III and IV HF received a single 24 h levosimendan infusion. Non-invasive haemodynamics (inert gas re-breathing technique), estimated glomerular filtration rate, and N-terminal pro-brain natriuretic peptide were assessed before and after infusion. Levosimendan had the following effects (median change): a significant increase in cardiac output (+9.8 ± 21.6%; P = 0.026) and decrease in N-terminal pro-brain natriuretic peptide (-28.1 ± 16.3%, P < 0.001), estimated total peripheral resistance (-16.9 ± 18.3%, P = 0.005), and mean arterial pressure (-5.9 ± 8.2%, P = 0.007), but no change in estimated glomerular filtration rate (+0.89 ± 14.0%, P = 0.955). There were no significant associations between baseline clinical and/or haemodynamic factors and the levosimendan effect on cardiac output.

Conclusions: Levosimendan was associated with improved haemodynamics in patients with stable chronic HF, but we could not identify any predictors of the magnitude of haemodynamic response.

Keywords: Cardiac output; Heart failure; Inodilator; Inotrope; Levosimendan; Repetitive treatment.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cardiotonic Agents / administration & dosage
  • Dose-Response Relationship, Drug
  • Female
  • Follow-Up Studies
  • Heart Failure / drug therapy*
  • Heart Failure / physiopathology
  • Hemodynamics / drug effects
  • Hemodynamics / ethics*
  • Humans
  • Infusions, Intravenous
  • Male
  • Middle Aged
  • Prospective Studies
  • Simendan / administration & dosage*
  • Treatment Outcome

Substances

  • Cardiotonic Agents
  • Simendan