Abstract 2945: Increase of Coronary Flow After Levosimendan Infusion is Associated with Improvement in Cardiac Performance in Patients with Decompensated Heart Failure
Levosimendan is a novel calcium sensitizer which improves cardiac contractility without increasing myocardial oxygen demand. We examined the effects of levosimendan infusion on coronary flow and the relation between changes in coronary flow and the reciprocal changes in BNP, in echocardiographic and clinical indices of cardiac performance after levosimendan infusion in patients with decompensated heart failure.
Methods: We studied 42 patients, of mean age 62 ± 12 years, with heart failure (NYHA III-IV) refractory to conventional therapy and LV ejection fraction (EF) 22 ± 16%. Patients were randomized to receive levosimendan 0.1 μg/kg/min (n = 21) or placebo (n = 21) for 24 hours. Before and 48h after each treatment patients underwent: A) assessment of max, mean and time integral (VTI) of the coronary flow velocity (CFV) in LAD using a 7MHZ transducer during colour-guided Doppler echocardiography, of RV systolic pressure (RVSP) by means of Doppler echocardiography, of E /E’ ratio using Doppler imaging of mitral inflow velocity and tissue Doppler imaging of the mitral annulus and of LVEF B) measurement of plasma BNP levels
Results: There were no differences in baseline characteristics between patients receiving levosimendan or placebo. ANOVA showed that there was a greater increase in max, mean and VTI -CFV and decrease in BNP levels, RVSP and E/E’ after levosimendan than after placebo (table⇓, p < 0.05). Compared to baseline, increasing VTI-CFV was related to an improvement in EF, E/E’, and BNP after treatment in patients receiving levosimendan (r = 0.69, r = −0.41and r = −0.80 p < 0.05 respectively).
Conclusion: Short-term levosimendan therapy improves coronary flow in parallel with improvement in cardiac function parameters in patients with heart failure