Document Detail

Right ventricular function in myocardial infarction complicated by cardiogenic shock: Improvement with levosimendan.
MedLine Citation:
PMID:  19661807     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: Levosimendan improves left ventricular hemodynamic function in patients with cardiogenic shock. However, its impact on right ventricular performance has not been determined. We compared the hemodynamic effects of levosimendan on left and right ventricular function in patients with intractable cardiogenic shock following myocardial infarction. DESIGN: Observational hemodynamic study. SETTING: Tertiary care center university hospital. PATIENTS: Fifty-six patients with cardiogenic shock secondary to myocardial infarction were treated with percutaneous revascularization (including intra-aortic balloon pump when appropriate) and commenced on conventional inotropic therapy. INTERVENTION: Twenty-five consecutive patients with cardiogenic shock due to myocardial infarction who had not improved sufficiently with conventional therapy (including dobutamine and norepinephrine) received levosimendan (as a bolus of 12 microg/kg per minute for 10 mins then 0.1 microg/kg per minute--0.2 mug/kg per minute) as "bail-out" therapy for 24 hrs while invasive hemodynamic parameters were recorded. MEASUREMENTS AND MAIN RESULTS: Levosimendan therapy was associated with a significant increase in cardiac index from 2.1 +/- 0.1 to 3.0 +/- 0.2 L x min x m (p < .01). In addition, levosimendan enhanced right ventricular cardiac power index (0.14 +/- 0.19 to 0.18W +/- 0.12, p < .001), while pulmonary vascular resistance fell from 227.7 +/- 94.5 to 178.1 +/- 62.3 dyne x s x cm (p = .002). No significant change in central venous pressure or mean pulmonary artery pressure was observed. The observed hemodynamic improvement was sustained after the levosimendan infusion was stopped. CONCLUSIONS: Levosimendan infusion for cardiogenic shock following acute myocardial infarction improved hemodynamic parameters of right ventricular performance. Furthermore, we describe the use of right ventricular cardiac power index as a hemodynamic parameter of right ventricular performance.
Martin A Russ; Roland Prondzinsky; Justin M Carter; Axel Schlitt; Henning Ebelt; Hendrik Schmidt; Henning Lemm; Konstantin Heinroth; Gerold Soeffker; Matthias Winkler; Karl Werdan; Michael Buerke
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Critical care medicine     Volume:  37     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-11-20     Completed Date:  2009-12-23     Revised Date:  2010-04-22    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3017-23     Citation Subset:  AIM; IM    
Department of Internal Medicine III, Martin Luther University Halle-Wittenberg, Halle/Saale, Germany.
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MeSH Terms
Aged, 80 and over
Hemodynamics / drug effects
Hydrazones / pharmacology*
Middle Aged
Myocardial Infarction / complications*,  physiopathology
Pyridazines / pharmacology*
Shock, Cardiogenic / drug therapy*,  etiology*,  physiopathology
Vasodilator Agents / pharmacology*
Ventricular Function, Left / drug effects*
Ventricular Function, Right / drug effects*
Reg. No./Substance:
0/Hydrazones; 0/Pyridazines; 0/Vasodilator Agents; 131741-08-7/simendan
Comment In:
Crit Care Med. 2009 Dec;37(12):3168-9   [PMID:  19923936 ]
Crit Care Med. 2010 May;38(5):1389-90; author reply 1390-1   [PMID:  20404640 ]

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