Effects of levosimendan versus dobutamine on left ventricular diastolic function in patients with cardiogenic shock after primary angioplasty

Background: Levosimendan is a new calcium sensitizer with positive inotropic properties. In previous studies, it has recently been shown that levosimendan improves the Doppler echocardiographic parameters of the left ventricular (LV) diastolic function in patients with anterior acute myocardial infarction. We sought to evaluate the effects of levosimendan compared to dobutamine on LV diastolic function, using conventional transmitral Doppler, in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) who subsequently developed cardiogenic shock. Methods: We randomized 22 consecutive STEMI patients with cardiogenic shock after primary PCI to levosimendan or dobutamine infusion and we also analyzed the diastolic function using conventional transmitral Doppler flow. Results: Twenty-four hours after the initiation of the drug infusion, patients treated with levosimendan (n=11) showed a significant reduction of the isovolumetric relaxation time (116 +/- 15.2-70.4 +/- 10.8 ms; P <.001), and a significant increase of the E/A ratio (0.6 +/- 0.3-1.4 +/- 0.5; P <.001). In the dobutamine group (n=11), no statistically significant differences were noted in the echocardiographic Doppler indexes. Conclusion: Levosimendan seems to be effective in improving the Doppler echocardiographic parameters of LV diastolic function in patients with STEMI revascularised by primary PCI who developed cardiogenic shock. (c) 2007 Elsevier Ireland Ltd. All rights reserved.