Document Detail

Levosimendan restores both systolic and diastolic cardiac performance in lipopolysaccharide-treated rabbits: comparison with dobutamine and milrinone.
MedLine Citation:
PMID:  17414729     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Current treatment strategies for severe septic conditions (i.e., intravenous fluids, vasopressors, and cardiac inotropes) reestablish fluid balance and improve cardiac systole but do not address diastolic dysfunction. Our study aimed to fully characterize both systolic and diastolic abnormalities of sepsis-associated heart failure and to identify treatment that would support full-cycle cardiac improvement. DESIGN: Endotoxin-injected rabbits, an animal model of abnormal cardiac function in human sepsis, were used to delineate cardiac abnormalities and to examine effects of drug treatments on heart systolic and diastolic function (n = 30); saline-injected animals served as comparators (n = 17). As treatment, three inotropes commonly used for treatment of cardiac failure were infused for 45 mins in separate animal groups-milrinone, dobutamine, and levosimendan. MEASUREMENTS: Variables of left ventricular systolic and diastolic function were assessed with a pressure conductance catheter. Measurements were made before and after endotoxin/saline injection and before and after inotrope treatment. RESULTS: Pressure-volume analyses of the left ventricle showed marked impairment in systolic function and in all indices of diastolic function (isovolumic relaxation time constant, left ventricular end-diastolic pressure, and end-diastolic pressure-volume relationship) in endotoxin-treated rabbits. The inotropes, milrinone, dobutamine, and levosimendan, could each partially or completely restore systolic function in the lipopolysaccharide-treated rabbits. However, only levosimendan therapy led to additional beneficial effects on left ventricular relaxation and diastolic function. CONCLUSIONS: Cardiac failure in severe sepsis results from impairments in both systolic and diastolic functions. Treatment with the calcium sensitizer levosimendan improved both systolic and diastolic cardiac functions in septic animals, but cyclic adenosine monophosphate-dependent inotropes milrinone and dobutamine only improved systolic function.
Damien Barraud; Valérie Faivre; Thibault Damy; Stéphane Welschbillig; Etienne Gayat; Christophe Heymes; Didier Payen; Ajay M Shah; Alexandre Mebazaa
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  35     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2007 May 
Date Detail:
Created Date:  2007-04-20     Completed Date:  2007-05-31     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1376-82     Citation Subset:  AIM; IM    
Equipe d'Accueil 322, Université, Paris, France.
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MeSH Terms
Cardiotonic Agents / pharmacology*,  therapeutic use
Diastole / drug effects*
Disease Models, Animal
Dobutamine / pharmacology,  therapeutic use
Heart Failure / drug therapy*,  etiology,  physiopathology
Hydrazones / pharmacology*,  therapeutic use
Milrinone / pharmacology,  therapeutic use
Pyridazines / pharmacology*,  therapeutic use
Sepsis / complications*
Systole / drug effects*
Ventricular Function, Left / drug effects*
Reg. No./Substance:
0/Cardiotonic Agents; 0/Hydrazones; 0/Lipopolysaccharides; 0/Pyridazines; 131741-08-7/simendan; 34368-04-2/Dobutamine; 78415-72-2/Milrinone

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