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Hu Y, Wei Z, Zhang C, Lu C, Zeng Z. The effect of levosimendan on right ventricular function in patients with heart dysfunction: a systematic review and meta-analysis. Sci Rep 2021; 11:24097. [PMID: 34916560 PMCID: PMC8677770 DOI: 10.1038/s41598-021-03317-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 12/01/2021] [Indexed: 11/11/2022] Open
Abstract
Levosimendan exerts positive inotropic and vasodilatory effects. Currently, its effects on right heart function remain uncertain. This systematic review and meta-analysis is intended to illustrate the impacts of levosimendan on systolic function of the right heart in patients with heart dysfunction. We systematically searched electronic databases (PubMed, the Cochrane Library, Embase and Web of Science) up to November 30, 2020, and filtered eligible studies that reported the impacts of levosimendan on right heart function. Of these, only studies whose patients suffered from heart dysfunction or pulmonary hypertension were included. Additionally, patients were divided into two groups (given levosimendan or not) in the initial research. Then, RevMan5.3 was used to conduct further analysis. A total of 8 studies comprising 390 patients were included. The results showed that after 24 h of levosimendan, patients' right ventricular fractional area change [3.17, 95% CI (2.03, 4.32), P < 0.00001], tricuspid annular plane systolic excursion [1.26, 95% CI (0.35, 2.16), P = 0.007] and tricuspid annular peak systolic velocity [0.86, 95% CI (0.41, 1.32), P = 0.0002] were significantly increased compared to the control group. And there is an increasing trend of cardiac output in levosimendan group [1.06, 95% CI (- 0.16, 2.29), P = 0.09 ] .Furthermore, patients' systolic pulmonary arterial pressure [- 5.57, 95% CI (- 7.60, - 3.54), P < 0.00001] and mean pulmonary arterial pressure [- 1.01, 95% CI (- 1.64, - 0.37), P = 0.002] were both significantly decreased, whereas changes in pulmonary vascular resistance [- 55.88, 95% CI (- 206.57, 94.82), P = 0.47] were not significant. Our study shows that in patients with heart dysfunction, levosimendan improves systolic function of the right heart and decreases the pressure of the pulmonary artery.
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Affiliation(s)
- Yaoshi Hu
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
- Guangxi Key Laboratory of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention, Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning, 530021, Guangxi, China
| | - Zhe Wei
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Chaoyong Zhang
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
- Guangxi Key Laboratory of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention, Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning, 530021, Guangxi, China
| | - Chuanghong Lu
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
- Guangxi Key Laboratory of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention, Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning, 530021, Guangxi, China
| | - Zhiyu Zeng
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China.
- Guangxi Key Laboratory of Precision Medicine in Cardio-Cerebrovascular Diseases Control and Prevention, Guangxi Clinical Research Center for Cardio-Cerebrovascular Diseases, Nanning, 530021, Guangxi, China.
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The effects of levosimendan use on high-sensitivity C-reactive protein in patients with decompensated heart failure. ACTA ACUST UNITED AC 2019; 4:e174-e179. [PMID: 31448350 PMCID: PMC6705148 DOI: 10.5114/amsad.2019.86803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 06/22/2019] [Indexed: 11/25/2022]
Abstract
Introduction The present study was intended to investigate the effect of levosimendan on high-sensitivity C-reactive protein (hsCRP) levels in hospitalized patients with decompensated heart failure. Material and methods The present study was designed as a prospective controlled clinical trial. A total of 50 patients with decompensated heart failure who were admitted to our hospital were included in the present study. Patients with stage III–IV heart failure based on the New York Heart Association, with systolic blood pressure > 100 mm Hg and with left ventricular ejection fraction of < 35%, were selected for the study population. The selected patients were divided into groups, levosimendan and furosemide. Results There was no significant difference between the groups based on demographics, basal echocardiographic and basal laboratory data. No difference was determined in basal hsCRP (mg/l) levels between the group admitted levosimendan infusion and the furosemide group (9.99 ±6.2, 9.23 ±6.4, p = 0.66). However, the hsCRP levels measured at the 24th h (38.34 ±32.1 vs. 12.97 ±12.3, p < 0.001), the 48th h (31.13 ±29.9 vs. 12.44 ±10.1, p = 0.003) and the 72nd h (27.41 ±26.9 vs. 9.89 ±8.4, p = 0.002) were significantly higher in the levosimendan infusion group than the furosemide group. Conclusions It was found that hsCRP levels were significantly higher in the levosimendan infusion group than the furosemide group. Such an outcome could be related to myocyte injury and/or the amplification of the inflammatory response due to levosimendan.
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Kresoja KP, Schmidt G, Kherad B, Krackhardt F, Spillmann F, Tschöpe C. Akute und chronische Herzinsuffizienz. Herz 2017; 42:699-712. [DOI: 10.1007/s00059-017-4613-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Krzysztofik J, Ponikowski P. Current and emerging pharmacologic options for the management of patients with chronic and acute decompensated heart failure. Expert Rev Clin Pharmacol 2017; 10:517-534. [PMID: 28358228 DOI: 10.1080/17512433.2017.1299574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION For many years heart failure (HF) was known as a fatal disease with an ominous prognosis. In the last decades better understanding of the pathophysiological mechanisms underlying HF has resulted in major breakthrough in the management and improvement in the natural history of this clinical syndrome. Areas covered: The review is focused on current and upcoming pharmacological therapies in patients with chronic and acute HF, starting with brief overview of drugs which improve the outcomes in patients with chronic HF with reduced ejection fraction (EF) including neurohormonal antagonists, angiotensin receptor neprilysin inhibitor and If- channel inhibitor, then presenting the summary of symptomatic treatment, the pharmacotherapy in chronic HF with preserved and mid-range EF and in acute HF. Finally, we report the emerging pharmacologic options and ongoing clinical trials and future directions in pharmacotherapy. Expert commentary: The guidelines-recommended therapies in HF with reduced EF need to be widely implemented into the everyday clinical practice. Better clinical characterization of HF with preserved, mid-range EF and acute HF, with better understanding of the underlying pathophysiological mechanisms may ultimately result in a development of effective strategies improving ominous outcomes in these patients.
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Affiliation(s)
- Justyna Krzysztofik
- a Department of Heart Diseases , Wroclaw Medical University , Wroclaw , Poland.,b 4th Military Hospital, Cardiology Department , Centre for Heart Diseases , Wroclaw , Poland
| | - Piotr Ponikowski
- a Department of Heart Diseases , Wroclaw Medical University , Wroclaw , Poland.,b 4th Military Hospital, Cardiology Department , Centre for Heart Diseases , Wroclaw , Poland
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Gong B, Li Z, Yat Wong PC. Levosimendan Treatment for Heart Failure: A Systematic Review and Meta-Analysis. J Cardiothorac Vasc Anesth 2015; 29:1415-25. [DOI: 10.1053/j.jvca.2015.03.023] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Indexed: 11/11/2022]
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Parissis JT, Papadakis J, Kadoglou NP, Varounis C, Psarogiannakopoulos P, Rafouli-Stergiou P, Ikonomidis I, Paraskevaidis I, Dimopoulou I, Zerva A, Dima K, Anastasiou-Nana M, Filippatos G. Prognostic value of high sensitivity troponin T in patients with acutely decompensated heart failure and non-detectable conventional troponin T levels. Int J Cardiol 2013; 168:3609-12. [DOI: 10.1016/j.ijcard.2013.05.056] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 01/27/2013] [Accepted: 05/04/2013] [Indexed: 10/26/2022]
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Abstract
PURPOSE OF REVIEW ICU patients frequently develop low output syndromes due to cardiac dysfunction, myocardial injury, and inflammatory activation. Conventional inotropic agents seem to be useful in restoring hemodynamic parameters and improving peripheral organ perfusion, but can increase short-term and long-term mortality in these patients. Novel inotropes may be promising in the management of ICU patients, having no serious adverse effects. This review summarizes all the current knowledge about the use of conventional and new inotropic agents in various clinical entities of critically ill patients. RECENT FINDINGS In recent European Society of Cardiology guidelines, inotropic agents are administered in patients with low output syndrome due to impaired cardiac contractility, and signs and symptoms of congestion. The most recommended inotropes in this condition are levosimendan and dobutamine (both class of recommendation: IIa, level of evidence: B). Recent data indicate that levosimendan may be useful in postmyocardial infarction cardiac dysfunction and septic shock through increasing coronary flow and attenuating inflammatory activation, respectively. Furthermore, calcium sensitizing by levosimendan can be effectively used for weaning of mechanical ventilation in postcardiac surgery patients and has also cardioprotective effect as expressed by the absence of troponin release in this patient population. Finally, new agents, such as istaroxime and cardiac myosin activators may be safe and improve central hemodynamics in experimental models of heart failure and heart failure patients in phase II clinical trials; however, large-scale randomized clinical trials are required. SUMMARY In an acute cardiac care setting, short-term use of inotropic agents is crucial for the restoration of arterial blood pressure and peripheral tissue perfusion, as well as weaning of cardiosurgery. New promising agents should be tested in randomized clinical trials.
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Farmakis D, Parissis JT, Bistola V, Paraskevaidis IA, Iliodromitis EK, Filippatos G, Kremastinos DT. Plasma B-type natriuretic peptide reduction predicts long-term response to levosimendan therapy in acutely decompensated chronic heart failure. Int J Cardiol 2010; 139:75-9. [DOI: 10.1016/j.ijcard.2008.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2008] [Accepted: 10/01/2008] [Indexed: 10/21/2022]
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Liu T, Li G, Xu G. Levosimendan May Prevent Postoperative Atrial Fibrillation Through Anti-inflammatory and Antioxidant Modulation. J Cardiothorac Vasc Anesth 2009; 23:757-8. [PMID: 19101169 DOI: 10.1053/j.jvca.2008.09.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2008] [Indexed: 12/20/2022]
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Pharmacologic Stabilization and Management of Acute Heart Failure Syndromes in the Emergency Department. Heart Fail Clin 2009; 5:43-54, vi. [DOI: 10.1016/j.hfc.2008.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Parissis JT, Rafouli-Stergiou P, Paraskevaidis I, Mebazaa A. Levosimendan: from basic science to clinical practice. Heart Fail Rev 2008; 14:265-75. [DOI: 10.1007/s10741-008-9128-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Accepted: 11/28/2008] [Indexed: 12/01/2022]
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Parissis JT, Andreadou I, Bistola V, Paraskevaidis I, Filippatos G, Kremastinos DT. Novel biologic mechanisms of levosimendan and its effect on the failing heart. Expert Opin Investig Drugs 2008; 17:1143-50. [DOI: 10.1517/13543784.17.8.1143] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- John T Parissis
- University of Athens and Attikon General Hospital, Heart Failure Clinic and Second Cardiology Department, Navarinou 13, 15122 Maroussi, Athens, Greece ;
| | - Ioanna Andreadou
- University of Athens and Attikon General Hospital, Heart Failure Clinic and Second Cardiology Department, Navarinou 13, 15122 Maroussi, Athens, Greece ;
| | - Vassiliki Bistola
- University of Athens and Attikon General Hospital, Heart Failure Clinic and Second Cardiology Department, Navarinou 13, 15122 Maroussi, Athens, Greece ;
| | - Ioannis Paraskevaidis
- University of Athens and Attikon General Hospital, Heart Failure Clinic and Second Cardiology Department, Navarinou 13, 15122 Maroussi, Athens, Greece ;
| | - Gerasimos Filippatos
- University of Athens and Attikon General Hospital, Heart Failure Clinic and Second Cardiology Department, Navarinou 13, 15122 Maroussi, Athens, Greece ;
| | - Dimitrios T Kremastinos
- University of Athens and Attikon General Hospital, Heart Failure Clinic and Second Cardiology Department, Navarinou 13, 15122 Maroussi, Athens, Greece ;
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De Luca L, Mebazaa A, Filippatos G, Parissis JT, Böhm M, Voors AA, Nieminen M, Zannad F, Rhodes A, El-Banayosy A, Dickstein K, Gheorghiade M. Overview of emerging pharmacologic agents for acute heart failure syndromes. Eur J Heart Fail 2008; 10:201-13. [PMID: 18279775 DOI: 10.1016/j.ejheart.2008.01.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2007] [Revised: 11/15/2007] [Accepted: 01/02/2008] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Several therapies commonly used for the treatment of acute heart failure syndromes (AHFS) present some well-known limitations and have been associated with an early increase in the risk of death. There is, therefore, an unmet need for new pharmacologic agents for the early management of AHFS that may improve both short- and long-term outcomes. AIM To review the recent evidence on emerging pharmacologic therapies in AHFS. METHODS A systematic search of peer-reviewed publications was performed on MEDLINE, EMBASE and Clinical Trials.gov from January 1990 to August 2007. The results of unpublished or ongoing trials were obtained from presentations at national and international meetings and pharmaceutical industry releases. Bibliographies from these references were also reviewed, as were additional articles identified by content experts. RESULTS Cumulative data from large studies and randomised trials suggest that therapies with innovative mechanisms of action may safely and effectively reduce pulmonary congestion or improve cardiac performance in AHFS patients. CONCLUSION Some investigational agents for the management of AHFS are able to improve haemodynamics and/or clinical status. In spite of these promising findings, no new agent has demonstrated a clear benefit in terms of long-term clinical outcomes compared to placebo or conventional therapies.
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Affiliation(s)
- Leonardo De Luca
- Department of Cardiovascular Sciences, European Hospital, Rome, Italy
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Pérez Vela JL, Corres Peiretti MA, Rubio Regidor M, Hernández Tejedor A, Renes Carreño E, Arribas López P, Gutiérrez Rodríguez J, Rodríguez de Viguri NP. Utilidad de levosimendán en la disfunción ventricular postoperatoria del injerto en el trasplante cardiaco. Rev Esp Cardiol (Engl Ed) 2008. [DOI: 10.1157/13119998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Effects of levosimendan on flow-mediated vasodilation and soluble adhesion molecules in patients with advanced chronic heart failure. Atherosclerosis 2008; 197:278-82. [DOI: 10.1016/j.atherosclerosis.2007.04.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Revised: 04/20/2007] [Accepted: 04/20/2007] [Indexed: 11/20/2022]
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Practical recommendations for prehospital and early in-hospital management of patients presenting with acute heart failure syndromes. Crit Care Med 2008; 36:S129-39. [PMID: 18158472 DOI: 10.1097/01.ccm.0000296274.51933.4c] [Citation(s) in RCA: 178] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Guideline recommendations for the prehospital and early in-hospital (first 6-12 hrs after presentation) management of acute heart failure syndromes are lacking. The American College of Cardiology/American Heart Association and European Society of Cardiology guidelines direct the management of these acute heart failure patients, but specific consensus on early management has not been published, primarily because few early management trials have been conducted. This article summarizes practical recommendations for the prehospital and early management of patients with acute heart failure syndromes; the recommendations were developed from a meeting of experts in cardiology, emergency medicine, and intensive care medicine from Europe and the United States. The recommendations are based on a unique clinical classification system considering the initial systolic blood pressure and other symptoms: 1) dyspnea and/or congestion with systolic blood pressure >140 mm Hg; 2) dyspnea and/or congestion with systolic blood pressure 100-140 mm Hg; 3) dyspnea and/or congestion with systolic blood pressure <100 mm Hg; 4) dyspnea and/or congestion with signs of acute coronary syndrome; and 5) isolated right ventricular failure. These practical recommendations are not intended to replace existing guidelines. Rather, they are meant to serve as a tool to facilitate guideline implementation where data are available and to provide suggested treatment approaches where formal guidelines and definitive evidence are lacking.
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Parissis JT, Andreadou I, Markantonis SL, Bistola V, Louka A, Pyriochou A, Paraskevaidis I, Filippatos G, Iliodromitis EK, Kremastinos DT. Effects of Levosimendan on circulating markers of oxidative and nitrosative stress in patients with advanced heart failure. Atherosclerosis 2007; 195:e210-5. [PMID: 17707851 DOI: 10.1016/j.atherosclerosis.2007.07.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 06/20/2007] [Accepted: 07/11/2007] [Indexed: 11/27/2022]
Abstract
BACKGROUND Oxidative stress is associated with maladaptive cardiac remodeling and vascular dysfunction and may be an important contributor to chronic heart failure (CHF) deterioration. We sought to investigate if the calcium sensitizer levosimendan beneficially modulates circulating markers of oxidative and nitrosative stress thus lessening their deleterious effects in patients with advanced CHF. METHODS Thirty-nine patients with advanced CHF (mean NYHA 3.5+/-0.4; ischemic/dilated: 23/16; mean left ventricular ejection fraction: 26+/-7%) who were hospitalized due to syndrome worsening, were randomized (2:1) to receive either a 24-h levosimendan infusion of 0.1 microg/(kg min) (n=26) or placebo (n=13). Plasma b-type natriuretic peptide (BNP), circulating markers of oxidative [protein carbonyls, malondialdehyde (MDA)] and nitrosative (nitrotyrosine) stress, and cyclic GMP (cGMP) were measured at baseline and 48 h after each treatment. RESULTS Baseline characteristics and medications were well balanced in the two treatment groups. A significant improvement in left ventricular ejection fraction (P<0.01), NYHA class (P<0.01), and plasma BNP (P<0.01) was observed post-treatment only in the levosimendan group. Markers such as MDA, protein carbonyls and nitrotyrosine remained stable in the levosimendan-treated group, but significantly increased (P<0.05) in the placebo-treated patients. Neither therapeutic intervention changed the levels of circulating cGMP. CONCLUSION Levosimendan does not increase markers of oxidative and nitrosative stress in contrast to the placebo treatment, thus, exerting cardioprotective effects in advanced CHF patients. Moreover, levosimendan may exert its biologic action through non-cGMP-dependent biochemical pathways.
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Affiliation(s)
- John T Parissis
- Heart Failure Unit, Attikon University Hospital, Athens, Greece
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Abstracts of the 5th International Meeting on Intensive Cardiac Care, October 14-16, 2007, Tel Aviv, Israel. ACTA ACUST UNITED AC 2007; 9:134-74. [PMID: 17917844 DOI: 10.1080/17482940701649731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Mavrogeni S, Giamouzis G, Papadopoulou E, Thomopoulou S, Dritsas A, Athanasopoulos G, Adreanides E, Vassiliadis I, Spargias K, Panagiotakos D, Cokkinos DV. A 6-Month Follow-up of Intermittent Levosimendan Administration Effect on Systolic Function, Specific Activity Questionnaire, and Arrhythmia in Advanced Heart Failure. J Card Fail 2007; 13:556-9. [PMID: 17826646 DOI: 10.1016/j.cardfail.2007.04.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2006] [Revised: 03/24/2007] [Accepted: 04/17/2007] [Indexed: 11/20/2022]
Abstract
BACKGROUND Levosimendan (LS) improves cardiac contractility without increasing myocardial oxygen demand. We administrated LS on a monthly intermittent 24-hour protocol and evaluated the clinical effect after 6 months in a randomized, open, prospective study. METHODS AND RESULTS Fifty patients (age 45-65 years) with LV systolic dysfunction and New York Heart Association (NYHA) III or IV were randomized in 2 groups. LS group (n = 25) was compared with a control group (n = 25) matched for sex, age, and NYHA class. LS was given monthly on a 24-hour intravenous protocol for 6 months. Patients were evaluated by specific activity questionnaire (SAQ) and echocardiography (ECHO) before and 3 to 5 days after last drug administration, whereas 24-hour Holter recording was performed before and during last drug administration. Patients in LS and control group had same baseline SAQ, ECHO, and Holter parameters. At the end of the study, a larger proportion of patients in the levosimendan group reported improvement in symptoms (dyspnea and fatigue) (65% versus 20% in controls, P < .01). After 6 months, the LS group had a significant increase in LV ejection fraction versus controls (28 +/- 7 versus 21 +/- 4 %, P = .003), LV shortening fraction (15 +/- 3 versus 11 +/- 3 %, P = .006) and a decrease in mitral regurgitation (1.5 +/- 0.8 versus 2.7 +/- 0.6, P = .0001). There was no increase in supraventricular or ventricular beats or supraventricular tachycardia and VT episodes in LS group, compared with controls. Two patients from the LS group died in the 6-month follow-up period, compared with 8 patients in the control group (8% versus 32%, P < .05). CONCLUSIONS A 6-month intermittent LS treatment in patients with decompensated advanced heart failure improved symptoms and LV systolic function.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Anti-Arrhythmia Agents/administration & dosage
- Anti-Arrhythmia Agents/therapeutic use
- Arrhythmias, Cardiac/complications
- Arrhythmias, Cardiac/diagnostic imaging
- Arrhythmias, Cardiac/drug therapy
- Arrhythmias, Cardiac/mortality
- Arrhythmias, Cardiac/physiopathology
- Cardiac Output, Low/complications
- Cardiac Output, Low/diagnostic imaging
- Cardiac Output, Low/drug therapy
- Cardiac Output, Low/mortality
- Cardiac Output, Low/physiopathology
- Cardiotonic Agents/administration & dosage
- Cardiotonic Agents/therapeutic use
- Drug Administration Schedule
- Echocardiography
- Electrocardiography, Ambulatory
- Female
- Follow-Up Studies
- Humans
- Hydrazones/administration & dosage
- Hydrazones/therapeutic use
- Middle Aged
- Mitral Valve Insufficiency/complications
- Mitral Valve Insufficiency/physiopathology
- Myocardial Contraction
- Pyridazines/administration & dosage
- Pyridazines/therapeutic use
- Simendan
- Stroke Volume
- Surveys and Questionnaires
- Systole
- Ventricular Dysfunction, Left/complications
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Function, Left/drug effects
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Llorens-Soriano P, Carbajosa-Dalmau J, Fernández-Cañadas J, Murcia-Zaragoza J, Climent-Payá V, Laghzaoui F, Diéguez-Zaragoza S, Carrasco-Moreno R. Experiencia clínica con levosimendán en un servicio de urgencias de un hospital de tercer nivel. Rev Esp Cardiol 2007. [DOI: 10.1157/13109003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Parissis JT, Farmakis D, Praskevaidis I, Bistola V, Filippatos G, Kremastinos DT. Reply. Am J Cardiol 2007. [DOI: 10.1016/j.amjcard.2007.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Parissis JT, Papadopoulos C, Nikolaou M, Bistola V, Farmakis D, Paraskevaidis I, Filippatos G, Kremastinos D. Effects of Levosimendan on Quality of Life and Emotional Stress in Advanced Heart Failure Patients. Cardiovasc Drugs Ther 2007; 21:263-8. [PMID: 17610056 DOI: 10.1007/s10557-007-6034-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM Levosimendan improves central hemodynamics and symptoms in acutely decompensated chronic heart failure (CHF) patients. However, its effects on quality of life, emotional stress and functional capacity of patients with advanced CHF have not been properly investigated. METHODS AND RESULTS Sixty-three advanced CHF patients (NYHA III-IV, LVEF<30%) were randomized (2:1) to receive either a 24-h levosimendan infusion of 0.1 mug/kg/min or placebo. Questionnaires addressing quality of life [Kansas City Cardiomyopathy Questionnaire (KCCQ), functional and overall, Duke's Activity Status Index (DASI)] and emotional stress [Zung self-rating depression scale (SDS), Beck Depression Inventory (BDI)], as well as plasma BNP and 6-min walking distance (6MWT as a marker of exercise capacity) were assessed before treatment and at hospital discharge. A significant improvement in NYHA class (2.1 +/- 0.7 from 3.3 +/- 0.7, p < 0.01), 6 MWT (305 +/- 152 from 215 +/- 142 m, p < 0.01) and plasma BNP (598 +/- 398 from 1,078 +/- 756 pg/ml, p < 0.01) was observed post-treatment only in levosimendan-treated group. KCCQ functional (45 +/- 19 from 35 +/- 17%, p < 0.05) and overall (34 +/- 13 from 28 +/- 11%, p < 0.05), DASI (26 +/- 13 from 22 +/- 12, p < 0.05), Zung SDS (38 +/- 12 from 42 +/- 13, p < 0.01) and BDI (11 +/- 6 from 14 +/- 8, p < 0.05) scores also improved in levosimendan-treated patients, while remained unchanged in the placebo group. The hospital length stay was shorter in levosimendan group compared to placebo (3.2 +/- 1.7 versus 5.8 +/- 2.1 days, p < 0.01). Levosimendan-induced BNP reduction was significantly correlated with concomitant increase in 6MWT (r = 0.643, p < 0.001) as well as with the decrease of BDI (r = 0.30, p < 0.05) and Zung SDS (r = 0.25, p = 0.05). CONCLUSION Levosimendan seems to have a beneficial effect on quality of life, physical activity and emotional stress in advanced CHF patients, reducing concurrently hospitalization length.
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Affiliation(s)
- John T Parissis
- Second Cardiology Department and Heart Failure Unit, University of Athens Medical School, Attikon University Hospital, Athens, Greece.
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Abstract
Acute heat failure syndromes are a heterogenous group of conditions. Chronic heart failure exacerbations represent the vast majority of cases. Pathophysiologic mechanisms, such as hypotension with peripheral tissue hypoperfusion, renal function impairment and myocardial ischemia and injury, adversely affect patients' clinical outcome. Classical inotropes, such as beta-agonists (dobutamine, dopamine) and phosphodiesterase inhibitors (milrinone), seem to improve clinical symptoms and hemodynamics of acutely decompensated chronic heat failure patients, but they have been associated with increased long-term mortality. Thus, on the basis of the available evidence, these agents can be used only as a temporary treatment of acute heart failure exacerbations with stringent criteria (ESC AHF guidelines), resistant to intravenous vasodilators and/or diuretics when systolic blood pressure (SBP) is >100 mmHg or as a first-line treatment in patients with worsening of chronic cardiac failure and low SBP (<100 mmHg). The calcium sensitizer levosimendan is a new cardiac enhancer that seems to be more effective than classical inotropes in improving cardiac mechanical efficiency and reducing congestion, without causing cardiomyocyte death or increasing myocardial oxygen uptake. Recent randomized trials showed that levosimendan is not superior to placebo or dobutamine in improving 1- and 6-month mortality, although it caused a greater reduction of neurohormonal response. More data are needed regarding patient selection and the optimum regimen and dosing of levosimendan before this treatment modality become the first line therapy of acutely decompensated chronic heart failure patients.
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Affiliation(s)
- John T Parissis
- Heart Failure Unit, Attikon University Hospital, Athens, Greece.
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Parissis JT, Farmakis D, Bistola V, Adamopoulos S, Kremastinos DT. Levosimendan for the treatment of acute heart failure syndromes: time to identify subpopulations of responding patients. Am J Cardiol 2007; 99:146-7. [PMID: 17196480 DOI: 10.1016/j.amjcard.2006.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2006] [Revised: 10/09/2006] [Accepted: 10/09/2006] [Indexed: 11/23/2022]
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Parissis JT, Paraskevaidis I, Bistola V, Farmakis D, Panou F, Kourea K, Nikolaou M, Filippatos G, Kremastinos D. Effects of levosimendan on right ventricular function in patients with advanced heart failure. Am J Cardiol 2006; 98:1489-92. [PMID: 17126656 DOI: 10.1016/j.amjcard.2006.06.052] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Revised: 06/21/2006] [Accepted: 06/21/2006] [Indexed: 11/20/2022]
Abstract
Right ventricular (RV) dysfunction frequently complicates advanced left ventricular heart failure and contributes to an unfavorable prognosis. Levosimendan is a novel inodilator that beneficially affects hemodynamics and left ventricular systolic and diastolic function in patients with advanced heart failure. However, its effects on RV function have not yet been properly assessed in these patients. In this randomized trial, the impact of levosimendan or placebo on various echocardiographic parameters of RV systolic and diastolic function was investigated in 54 patients with advanced heart failure due to left ventricular systolic dysfunction. Tissue Doppler imaging maximal systolic tricuspid annular velocity (S wave) increased significantly only in the levosimendan group (8.2 +/- 3.2 vs 9.0 +/- 3.0 cm/s, p <0.03). Tissue Doppler imaging RV early diastolic velocity (E wave) and the ratio of early to late diastolic velocities (E/A) also increased significantly after levosimendan administration (p <0.01 and p <0.05, respectively). Systolic pulmonary arterial pressure decreased significantly (54 +/- 11 vs 43 +/- 11 mm Hg, p <0.01) in the levosimendan-treated patients. Levosimendan beneficially modulated neurohormonal and inflammatory status by decreasing B-type natriuretic peptide levels (p <0.05) and by altering the ratio of interleukin-6 to interleukin-10 in favor of the latter (p <0.05). In conclusion, levosimendan could offer further therapeutic advantages in patients with advanced heart failure by improving systolic and diastolic RV function.
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Affiliation(s)
- John T Parissis
- Second Cardiology Department, Heart Failure Unit, University of Athens Medical School, Attikon University Hospital, Athens, Greece.
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Delgado JF. Levosimendán en la insuficiencia cardiaca aguda: pasado, presente y futuro. Rev Esp Cardiol 2006. [DOI: 10.1157/13087053] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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