Evaluation of Myocardial Contractility Determination with Tissue Tracking Echocardiography after Levosimendan Infusion in Patients with Poor Left Ventricular Function and Hemodynamics

Background: The aim of this study was to assess the effect of conventional inotropic drugs compared to levosimendan using tissue tracking echocardiography in the early postoperative period for patients with low ejection fraction undergoing coronary artery bypass graft (CABG) surgery. Methods: We prospectively analyzed 115 patients (69 male, 46 female) who planned for elective coronary artery bypass surgery with low ejection fraction, <=% 30, from September 2012 to December 2013. Patients were divided into two groups. Levosimendan was used at a loading dose of 15 mu g/kg/min for the first twenty minutes, and continued at a maintenance dose of 0.2 mu g/kg/min six hours before the anesthetic induction in group I (n = 47, 23 male, mean age 67.16 +/- 4.72 years). Dopamine at 10 mu g/kg/min and/or dobutamine at 10 mu g/kg/min were used at the time of weaning from cardiopulmonary bypass in group II (n = 68, 47 male, mean age 65.43 +/- 6.12 years). The patients were evaluated preoperatively and on the fifth postoperative day by transthoracic echocardiography. Patients were also evaluated just before the cardiopulmonary bypass and at the 12th and 24th hours on the first postoperative day by transesophageal echocardiography. Student t test and chi(2) test were used for statistical analyses. Results: There were no significant differences in demographics and preoperative hemodynamic parameters between groups I and II. Hemodynamic and echocardiographic parameters were significantly better in group I receiving levosimendan, compared to group II. Conclusion: Levosimendan enhances functional myocardial tissue mass and ensures positive hemodynamic effect in the early postoperative period in patients with low ejection fraction undergoing elective CABG.