Document Detail


Acute effects of levosimendan on mitral regurgitation and diastolic function in patients with advanced chronic heart failure.
MedLine Citation:
PMID:  20613551     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: We analyzed the inodilator properties of levosimendan in patients with chronic heart failure and severe functional mitral regurgitation.
METHODS: We studied 20 patients under optimal treatment and in stable clinical condition (New York Heart Association 3.19 + or - 0.66; 70 + or - 7 years). Levosimendan was infused as a bolus (12 microg/kg in 10 min) followed by a 24-h infusion (0.1-0.2 microg/kg per min). Before and after infusion, Doppler echocardiography, brain natriuretic peptide determination and noninvasive hemodynamic monitoring with bioimpedance cardiography were performed.
RESULTS: Levosimendan improved left ventricular ejection fraction (ejection fraction 31 + or - 4 from 27 + or - 4, P < 0.05), decreased brain natriuretic peptide (333 + or - 139 from 629 + or - 63 pg/ml, P < 0.01), reduced mitral valve effective regurgitant orifice area to 27 + or - 5 from 36 + or - 7 mm (P < 0.01) and the velocity of displacement of mitral annulus [ratio between E and E' waves on Doppler and tissue Doppler (E/E') from 22.7 + or - 1.6 to 13.1 + or - 0.6, P < 0.01]. Noninvasive hemodynamic monitoring showed increased acceleration index (a marker of inotropism), and reduced peripheral resistances and thoracic fluid content (P < 0.01). After 4 weeks of washout, some of these effects were still evident.
CONCLUSION: In patients with chronic heart failure and functional mitral regurgitation, levosimendan acutely improved systolic and diastolic function, reduced mitral regurgitation and modulated neurohormonal activation, with a tendency for these changes to persist over a short-term follow-up.
Authors:
Giovanna Branzi; Gabriella Malfatto; Alessandra Villani; Francesca Ciambellotti; Miriam Revera; Alessia Giglio; Francesco Della Rosa; Mario Facchini; Gianfranco Parati
Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Journal of cardiovascular medicine (Hagerstown, Md.)     Volume:  11     ISSN:  1558-2035     ISO Abbreviation:  J Cardiovasc Med (Hagerstown)     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-07-30     Completed Date:  2010-11-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101259752     Medline TA:  J Cardiovasc Med (Hagerstown)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  662-8     Citation Subset:  IM    
Affiliation:
Divisione di Cardiologia, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Italy. branzi@auxologico.it
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MeSH Terms
Descriptor/Qualifier:
Aged
Cardiography, Impedance
Cardiotonic Agents / administration & dosage,  therapeutic use*
Chronic Disease
Diastole
Echocardiography, Doppler
Female
Heart Failure / diagnosis,  drug therapy*,  physiopathology
Hemodynamics / drug effects
Humans
Hydrazones / administration & dosage,  therapeutic use*
Infusions, Intravenous
Italy
Male
Middle Aged
Mitral Valve Insufficiency / diagnosis,  drug therapy*,  physiopathology
Natriuretic Peptide, Brain / blood
Pilot Projects
Pyridazines / administration & dosage,  therapeutic use*
Severity of Illness Index
Stroke Volume / drug effects
Systole
Time Factors
Treatment Outcome
Vasodilator Agents / administration & dosage,  therapeutic use*
Ventricular Function, Left / drug effects*
Chemical
Reg. No./Substance:
0/Cardiotonic Agents; 0/Hydrazones; 0/Pyridazines; 0/Vasodilator Agents; 114471-18-0/Natriuretic Peptide, Brain; 131741-08-7/simendan

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