Effects of levosimendan on restrictive left ventricular filling in severe heart failure - A combined hemodynamic and Doppler echocardiographic study

被引:34
作者
Dernellis, J [1 ]
Panaretou, MA [1 ]
机构
[1] Vostanion Hosp, Dept Cardiol, Mitilini, Greece
关键词
diastolic function; heart failure; levosimendan; pulmonary vein flow;
D O I
10.1378/chest.128.4.2633
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background: A restrictive pattern of left ventricular filling is often present in patients with severe heart failure. Although the hemodynamic effects of levosimendan have been studied, the effects of levosimendan on LV filling pattern have not been investigated. Methods: Pulsed-wave Doppler mitral (transthoracic) and pulmonary venous flow (transesophageal) velocity curves were recorded in 30 patients with a restrictive pattern of left ventricular filling with New York Heart Association class III or IV heart failure who had a documented left ventricular ejection fraction < 30% by echocardiography and received a 0.1 mu g/kg/min infusion of levosimendan for 24 h. Results: Levosimendan caused significant (p < 0.001) increases in stroke volume (from 46 +/- 4 to 57 +/- 4 mL) and decreases in pulmonary capillary wedge pressure (from 21 +/- 1 to 15 +/- 1 mm Hg). The E wave decreased (from 96 +/- 7 to 71 +/- 5 curls), and the A wave increased (from 40 +/- 4 to 46 +/- 4 cm/s). Moreover, deceleration time was increased (from 112 +/- 7 to 189 +/- 14 ms). The S wave of pulmonary venous flow was increased (from 38 +/- 3 to 60 +/- 3 cm/s), and atrial reversal was decreased (from 36 +/- 2 to 29 +/- 2 curls). All changes were significant (p < 0.001). Using stepwise linear regression analysis, we found that the percentage changes of the early/late transmitral diastolic peak flow velocity (E/A) ratio and the percentage changes of the isovolumetric relaxation time were independent predictors of the increase in cardiac output. Furthermore, the percentage changes of the systolic/diastolic ratio and the percentage changes of the E/A ratio were independent predictors of the decrease in pulmonary capillary wedge pressure. Conclusions: Treatment with levosimendan improved measures of left ventricular diastolic function. Consequently, left ventricular stroke volume was increased.
引用
收藏
页码:2633 / 2639
页数:7
相关论文
共 30 条
[1]   ESTIMATION OF LEFT-VENTRICULAR FILLING PRESSURES USING 2-DIMENSIONAL AND DOPPLER-ECHOCARDIOGRAPHY IN ADULT PATIENTS WITH CARDIAC DISEASE - ADDITIONAL VALUE OF ANALYZING LEFT ATRIAL SIZE, LEFT ATRIAL EJECTION FRACTION AND THE DIFFERENCE IN DURATION OF PULMONARY VENOUS AND MITRAL FLOW VELOCITY AT ATRIAL CONTRACTION [J].
APPLETON, CP ;
GALLOWAY, JM ;
GONZALEZ, MS ;
GABALLA, M ;
BASNIGHT, MA .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1993, 22 (07) :1972-1982
[2]   RELATION OF TRANSMITRAL FLOW VELOCITY PATTERNS TO LEFT-VENTRICULAR DIASTOLIC FUNCTION - NEW INSIGHTS FROM A COMBINED HEMODYNAMIC AND DOPPLER ECHOCARDIOGRAPHIC STUDY [J].
APPLETON, CP ;
HATLE, LK ;
POPP, RL .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1988, 12 (02) :426-440
[3]  
Cleland John G F, 2004, Expert Rev Cardiovasc Ther, V2, P9, DOI 10.1586/14779072.2.1.9
[4]   Aortic stiffness is an independent predictor of progression to hypertension in nonhypertensive subjects [J].
Dernellis, J ;
Panaretou, M .
HYPERTENSION, 2005, 45 (03) :426-431
[5]   Effects of postural changes on left atrial function in patients with hypertrophic cardiomyopathy [J].
Dernellis, J ;
Tsiamis, E ;
Stefanadis, C ;
Pitsavos, C ;
Toutouzas, P .
AMERICAN HEART JOURNAL, 1998, 136 (06) :982-987
[6]   Effects of digoxin on left atrial function in heart failure [J].
Dernellis, JM ;
Panaretou, MP .
HEART, 2003, 89 (11) :1308-1315
[7]   Left atrial mechanical adaptation to long-standing hemodynamic loads based on pressure-volume relations [J].
Dernellis, JM ;
Stefanadis, CI ;
Zacharoulis, AA ;
Toutouzas, PK .
AMERICAN JOURNAL OF CARDIOLOGY, 1998, 81 (09) :1138-1143
[8]   Prognostic value of pulmonary venous flow Doppler signal in left ventricular dysfunction - Contribution of the difference in duration of pulmonary venous and mitral flow at atrial contraction [J].
Dini, FL ;
Michelassi, C ;
Micheli, G ;
Rovai, D .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2000, 36 (04) :1295-1302
[9]   Efficacy and safety of intravenous levosimendan compared with dobutamine in severe low-output heart failure (the LIDO study): a randomised double-blind trial [J].
Follath, F ;
Cleland, JGF ;
Just, H ;
Papp, JGY ;
Scholz, H ;
Peuhkurinen, K ;
Harjola, VP ;
Mitrovic, V ;
Abdalla, M ;
Sandell, EP ;
Lehtonen, L .
LANCET, 2002, 360 (9328) :196-202
[10]  
Hajjar RJ, 1997, J PHARMACOL EXP THER, V280, P247