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European Journal of Heart Failure 2007 9(12):1172-1177; doi:10.1016/j.ejheart.2007.10.002
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© 2007 European Society of Cardiology

Effects of levosimendan on coronary artery flow and cardiac performance in patients with advanced heart failure

Ignatios Ikonomidis*, John T. Parissis, Ioannis Paraskevaidis, Kallirrhoe Kourea, Vasiliki Bistola, John Lekakis, Gerasimos Filippatos and Dimitrios Th. Kremastinos

Second Cardiology Department and Heart Failure Unit, University of Athens Medical School, Attikon University Hospital Athens, Greece

* Corresponding author. University of Athens, Attikon Hospital Perikleous 19, N. Chalkidona, Athens, 14343, Greece. Tel.: +30 6944805732; fax: +30 210 5832351. ignoik{at}otenet.gr (I. Ikonomidis).


  Abstract

Background: Levosimendan has inotropic and vasodilatory effects. We investigated the effects of levosimendan on coronary flow and associated changes in neurohormonal activation and cardiac performance in patients with advanced heart failure.

Methods: Forty-two patients with NYHA III–IV and a left ventricular ejection fraction (EF) 25±6%, were randomised to levosimendan 0.1 µg/kg/min (n=21) or placebo for 24 h. Before and 24 h after each treatment, we assessed: the maximal velocity (Vmax), time integral (VTI) and deceleration time (DT) of the diastolic coronary flow wave (CF) in LAD using transthoracic Doppler echocardiography, pulmonary artery systolic pressure by Doppler echocardiography, E/E' ratio using Doppler imaging of mitral inflow velocity, tissue Doppler imaging of the mitral annulus and B-type natriuretic peptide (BNP) levels.

Results: By ANOVA, there was a greater increase in CF-Vmax (43±23 vs.25±8 cm/s), CF-DT (904±250 vs. 667±151 ms), and EF and a greater decrease in BNP, pulmonary artery systolic pressure and E/E' after levosimendan than after placebo (p<0.05). Compared to baseline, the percent changes in CF-VTI were related to the concomitant changes in EF, E/E', and BNP after treatment with levosimendan (r=0.69, r=–0.51 and r=–0.80, p<0.05 respectively).

Conclusion: Treatment with levosimendan improves coronary flow and microcirculation in parallel with an improvement in cardiac performance and neurohormonal activation in patients with advanced heart failure.

Key Words: Levosimendan • Coronary flow • Echocardiography • Deceleration time microcirculation

Received June 13, 2007; Revised August 9, 2007; Accepted October 8, 2007


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