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Duration of the haemodynamic action of a 24‐h infusion of levosimendan in patients with congestive heart failure
Author(s) -
Lilleberg J.,
Laine M.,
Palkama T.,
Kivikko M.,
Pohjanjousi P.,
Kupari M.
Publication year - 2007
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/j.ejheart.2006.04.012
Subject(s) - levosimendan , medicine , heart failure , pulmonary wedge pressure , hemodynamics , ejection fraction , cardiology , cardiac output , anesthesia
Aims: To determine the duration of haemodynamic and neurohormonal action of a 24‐h infusion of levosimendan in heart failure. Methods and results: This was a double‐blind, parallel group study in patients with New York Heart Association class II to IV heart failure. Twenty‐two patients, with left ventricular ejection fraction <35% and pulmonary capillary wedge pressure (PCWP) above 12 mmHg, were randomised to receive either levosimendan (12 μg/kg followed by a continuous infusion of 0.1–0.2 μg/min) or placebo. Invasively measured cardiac output (CO) increased from 4.3 l/min to 5.4 l/min in the levosimendan group at 6 h. PCWP decreased from 20 mmHg to 15 mmHg in response to levosimendan. Echocardiographically measured maximal effect on PCWP occurred after 6 h, whereas CO reached its highest value at 24 h. The estimated duration of the decrease in PCWP was 7–9 days, and in CO was 12–13 days. Plasma NT‐proANP and NT‐proBNP levels reached their lowest values at days 3 and 2, and the treatment effect was estimated to last 16 and 12 days, respectively. The long‐acting haemodynamic responses reflect levels of the active metabolites OR‐1896 and OR‐1855, maximal metabolite levels occurred at day 3. Conclusions: Levosimendan infusion achieved a rapid improvement in haemodynamic parameters in patients with congestive heart failure with maximal effects occurring 1–3 days after starting the infusion, effects were sustained for up to at least a week.