The calcium sensitizer levosimendan improves the function of stunned myocardium after percutaneous transluminal coronary angioplasty in acute myocardial ischemia.

Abstract

OBJECTIVES:

We assessed the effects of levosimendan on left ventricular (LV) function in patients with acute myocardial ischemia and after coronary angioplasty.

BACKGROUND:

The calcium sensitizer levosimendan improves the function of myocardium in experimental stunning.

METHODS:

Twenty-four patients with an acute coronary syndrome underwent angioplasty followed by double-blinded, randomized treatment with 24 microg/kg of levosimendan (n = 16) or placebo (n = 8). Left ventricular pressures and volumes were recorded by cineventriculography and micromanometer-tipped catheters 10 min after angioplasty before drug administration (baseline) and 20 min after drug administration. Left ventricular function was assessed by the pressure-volume loop, and regional function analysis by the Slager method.

RESULTS:

The number of hypokinetic segments decreased with levosimendan, from 8.9 +/- 0.9 to 6.5 +/- 1.1 (mean +/- SEM), as compared with an increase from 7.8 +/- 1.0 to 8.5 +/- 1.1 with placebo (p = 0.016). A leftward and/or upward shift of the systolic part of the pressure-volume loop, indicating improved systolic function, was observed in eight of 16 of the levosimendan-treated and one of eight of the placebo patients (p = 0.178). In addition, the single-beat elastance was increased by levosimendan (p = 0.045). The pressure-volume area (p = 0.001), end-systolic pressure (p = 0.002), and volume index (p < 0.001) were decreased by levosimendan, but there was no change in the end-systolic pressure-volume ratio. End-diastolic pressure remained unchanged, whereas the end-diastolic volume index was decreased by levosimendan (p = 0.002). The time constant of isovolumic LV pressure fall decreased with levosimendan (p = 0.001).

CONCLUSIONS:

Levosimendan improved the function of stunned myocardium without obvious impairment of diastolic function.

• Authors: Steffen Sonntag, Stig Sundberg, Lasse Antero Lehtonen, Franz Xaver Kleber
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 43 Issue 12 Pg. 2177-82 (Jun 16 2004) ISSN: 0735-1097 [Print] United States
• PMID: 15193677 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Cardiotonic Agents
• Hydrazones
• Pyridazines
• Vasodilator Agents
• Simendan

Topics

• Acute Disease
• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Angioplasty, Balloon, Coronary
• Cardiac Volume (drug effects)
• Cardiotonic Agents (therapeutic use)
• Coronary Circulation (drug effects)
• Coronary Disease (physiopathology, therapy)
• Diastole (drug effects)
• Double-Blind Method
• Female
• Humans
• Hydrazones (therapeutic use)
• Male
• Middle Aged
• Myocardial Ischemia (physiopathology, therapy)
• Myocardial Stunning (physiopathology, therapy)
• Pyridazines (therapeutic use)
• Simendan
• Systole (drug effects)
• Treatment Outcome
• Vasodilation (drug effects)
• Vasodilator Agents (therapeutic use)
• Ventricular Function, Left (drug effects)
• Ventricular Pressure (drug effects)