HEMODYNAMIC INTERACTIONS OF A NEW CALCIUM SENSITIZING DRUG LEVOSIMENDAN AND CAPTOPRIL

Objective: Levosimendan in a new inodilator drug that sensitises tropo nin C in heart muscle cells to calcium, thus improving contractility. In previous studies, a single 2 mg intravenous dose of levosimendan in creased cardiac output (GO) in healthy volunteers by about 40% and dec reased pulmonary capillary wedge pressure in heart failure patients by 40-50%. The aim of the present, double-blind study was to evaluate th e safety of concomitant use of levosimendan and an ACE-inhibiting drug . Methods: The haemodynamic effects of levosimendan, given with or wit hout captopril, were evaluated by using 2-dimensional echocardiography , repeated blood pressure measurements and by ambulatory ECG recording s. Twenty-four male patients with stable NYHA II-III heart failure (EF < 40%) after a previous myocardial infarct were given, in randomised order, a single IV infusion of levosimendan or placebo. The infusions were repeated after 2 weeks treatment with upto 50 mg b.i.d. of captop ril. Twelve patients received levosimendan 1 mg and twelve received 2 mg. Results: Mean CO was increased from 6.0 to 6.81 . min(-1) in patie nts receiving 1 mg levosimendan compared to placebo, but only from 6.3 to 6.5 1 . min(-1) in patients receiving 2 mg. The increase in CO was statistically significant when all levosimendan patients were compare d to placebo. Heart rate did not change after either dose. Mean stroke volume increased significantly after 1 mg but not after 2 mg of levos imendan. The addition of captopril did not change the effects of levos imendan. No additional decrease in systolic or diastolic blood pressur e was observed when levosimendan and captopril were given concomitantl y. Conclusion: It seems that concomitant treatment with captopril does not change the haemodynamic effects of levosimendan. No adverse haemo dynamic interactions were seen.