Oral Levosimendan Increases Cerebral Blood Flow Velocities in Patients with a History of Stroke or Transient Ischemic Attack: A Pilot Safety Study - UTU Research Portal

A1 Refereed original research article in a scientific journal

Oral Levosimendan Increases Cerebral Blood Flow Velocities in Patients with a History of Stroke or Transient Ischemic Attack: A Pilot Safety Study

Authors: Kivikko Matti, Kuoppamäki Mikko, Soinne Lauri, Sundberg Stig, Pohjanjousi Pasi, Ellmen Juha, Roine Risto O

Publisher: Elsevier

Publication year: 2015

Journal: Current Therapeutic Research

Journal acronym: Curr Ther Clin Exp

Volume: 77

First page : 46

Last page: 51

Number of pages: 6

ISSN: 0011-393X

DOI: https://doi.org/10.1016/j.curtheres.2015.01.001

Abstract

Background

Intravenous levosimendan is indicated for acute heart failure. The compound has shown promising beneficial effects in ischemic stroke models.

Objective

We evaluated the efficacy and safety of oral levosimendan in patients with a history of cerebral ischemia.

Methods

In a randomized, double-blind, placebo-controlled, parallel-group study, 16 patients with a history of ischemic stroke/transient ischemic attack received oral levosimendan in 5 escalating doses from 0.125 to 2.0 mg daily for 18-day intervals of each dose; 5 patients received placebo. Twenty-four-hour ambulatory ECG and cerebral blood flow velocities using transcranial Doppler ultrasound were recorded at baseline and at the end of each dosing period. Vasomotor reactivity was assessed via the breath holding index. In addition, plasma levels of N-terminal-pro-B-type natriuretic peptide (NT-pro-BNP) and the metabolites of levosimendan were determined.

Results

Levosimendan induced an increase in cerebral blood flow velocities and a decrease in NT-pro-BNP compared with placebo. There was no significant effect on breath holding index. Doses ≥0.5 mg increased heart rate by 5 to 9 beats/min. The dose level of 2.0 mg exceeded the preset safety margin of ventricular extrasystoles per hour (ie, upper 90% CI of the ratio of levosimendan to placebo above 2) with an estimate of 3.10 (90% CI, 0.95–10.07).

Conclusions

Oral levosimendan increases cerebral blood flow velocities and diminishes NT-pro-BNP levels in patients with earlier ischemic cerebrovascular event. Daily doses up to 1.0 mg were well tolerated, whereas the 2.0 mg dose level induced an increase in ventricular extrasystoles. ClinicalTrials.gov identifier: NCT00698763.

Key words

ambulatory ECG;

cerebral blood flow;

levosimendan;

stroke;