A1 Refereed original research article in a scientific journal
Myocardial efficiency during levosimendan infusion in congestive heart failure
Authors: Ukkonen H, Saraste M, Akkila J, Knuuti J, Karanko M, Iida H, Lehikoinen P, Nagren K, Lehtonen L, Voipio-Pulkki LM
Publisher: WILEY
Publication year: 2000
Journal: Clinical Pharmacology and Therapeutics
Journal name in source: CLINICAL PHARMACOLOGY & THERAPEUTICS
Journal acronym: CLIN PHARMACOL THER
Volume: 68
Issue: 5
First page : 522
Last page: 531
Number of pages: 10
ISSN: 0009-9236
DOI: https://doi.org/10.1067/mcp.2000.110972
Abstract
Aims: Levosimendan, a novel calcium-dependent calcium sensitizer of the myocardial contractile proteins, also enhances diastolic relaxation and induces peripheral vasodilation by opening potassium channels. To assess the combined energetical effects of levosimendan infusion in vivo, we performed positron emission tomography in patients with decompensated chronic heart failure.Methods and Results: Eight hospitalized patients with New York Heart Association functional class III or IV heart failure received levosimendan or placebo intravenously in a randomized double-blind cross-over study, During steady-state, dynamic positron emission tomography with [C-11]acetate was used to assess myocardial oxygen consumption and [O-15]H2O to measure myocardial blood flow. Cardiac performance and dimensions were assessed by pulmonary artery catheterization and echocardiography, Compared with healthy volunteers, myocardial oxygen consumption during placebo was elevated in the right ventricle but comparable in the left ventricle, During administration of levosimendan, cardiac output increased by 32% (P = .002) mainly because of higher stroke volume. Coronary, pulmonary, and systemic vascular resistance values were significantly reduced. Mean myocardial blood flow increased from 0.76 to 1.02 mL/min/g (P = .033), Levosimendan was neutral on myocardial oxygen consumption and left ventricular efficiency but it improved right ventricular mechanical efficiency by 24% (P = .012),Conclusions: Levosimendan has an energetically favorable short-term profile in the treatment of congestive heart failure, It enhances cardiac output without oxygen wasting, particularly by improving efficiency in the right ventricle.
Aims: Levosimendan, a novel calcium-dependent calcium sensitizer of the myocardial contractile proteins, also enhances diastolic relaxation and induces peripheral vasodilation by opening potassium channels. To assess the combined energetical effects of levosimendan infusion in vivo, we performed positron emission tomography in patients with decompensated chronic heart failure.Methods and Results: Eight hospitalized patients with New York Heart Association functional class III or IV heart failure received levosimendan or placebo intravenously in a randomized double-blind cross-over study, During steady-state, dynamic positron emission tomography with [C-11]acetate was used to assess myocardial oxygen consumption and [O-15]H2O to measure myocardial blood flow. Cardiac performance and dimensions were assessed by pulmonary artery catheterization and echocardiography, Compared with healthy volunteers, myocardial oxygen consumption during placebo was elevated in the right ventricle but comparable in the left ventricle, During administration of levosimendan, cardiac output increased by 32% (P = .002) mainly because of higher stroke volume. Coronary, pulmonary, and systemic vascular resistance values were significantly reduced. Mean myocardial blood flow increased from 0.76 to 1.02 mL/min/g (P = .033), Levosimendan was neutral on myocardial oxygen consumption and left ventricular efficiency but it improved right ventricular mechanical efficiency by 24% (P = .012),Conclusions: Levosimendan has an energetically favorable short-term profile in the treatment of congestive heart failure, It enhances cardiac output without oxygen wasting, particularly by improving efficiency in the right ventricle.
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