Comparison of single-dose and repeated levosimendan infusion in patients with acute exacerbation of advanced heart failure
Abdurrahman Tasal, Mesut Demir, Mehmet Kanadasi, Ahmet Bacaksiz, Mehmet Akif Vatankulu, Durmus Yıldıray Sahin, Rabia Akıllı Eker, Abdi Bozkurt, Esmeray Acarturk
(Department of Cardiology, Bezmialem Vakif University, Istanbul, Turkey)
Med Sci Monit 2014; 20:276-282
Levosimendan (LS) is a novel inodilator that improves cardiac performance, central hemodynamics, and symptoms of patients with decompensated chronic heart failure. The aim of this study was to compare the effects of single and repeated LS infusion on left ventricular performance, biomarkers, and neurohormonal activation in patients with acute heart failure.
Material and Methods: Twenty-nine consecutive patients with acute exacerbation of advanced heart failure were included in this study. LS was initiated as a bolus of 6 μg/kg followed by a continuous infusion of 0.1 μg/kg/min for 24 hours in both groups who received intravenous single and repeated (baseline and at 1 and 3 months) treatment. Physical examination, echocardiography, and biochemical tests (brain natriuretic peptide, tumour necrosis factor-alpha, interleukin-1beta, 2, and 6) were performed before treatment and on 3 day of the treatment. The last evaluation was performed at 6 month after the baseline treatment.
Results: Twenty male and 9 female patients with mean age of 60.2±7.4 years were included in this study. A significant improvement in New York Heart Association functional status and myocardial performance index was detected only in the repeated LS treated patients at 6 month compared to the pretreatment status (p=0.03 and p<0.001; respectively). In addition, a significant decrease in brain natriuretic peptide (p<0.01) and plasma interleukin-6 (p=0.05) levels were also achieved only in patients who were given repeated LS.
Conclusions: Our study showed that repeated LS treatment is more effective compared to the single dose LS treatment in improving clinical status, hemodynamic and laboratory parameters in patients with acute exacerbation of advanced heart failure.
Keywords: LEVOSIMENDAN, Aged, Heart Failure, Biological Markers - metabolism, Dose-Response Relationship, Drug, Echocardiography, Female, Heart Failure - drug therapy, Heart Ventricles - drug effects, Humans, Hydrazones - therapeutic use, Infusions, Intravenous, Interleukin-1beta - metabolism, Interleukin-2 - metabolism, Interleukin-6 - metabolism, Male, Middle Aged, Natriuretic Peptide, Brain - metabolism, Pyridazines - therapeutic use, Tumor Necrosis Factor-alpha - metabolism, Turkey, Vasodilator Agents - therapeutic use