Vp. Harjola et al., Oral levosimendan improves cardiac function and hemodynamics in patients with severe congestive heart failure, AM J CARD, 83(12B), 1999, pp. 4I-8I
Citations number
20
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Levosimendan, a new calcium sensitizer, was administered orally to 10 patie
nts with severe congestive heart failure (CHF), who had a mean baseline pul
monary capillary wedge pressure (PCWP) of 22 mm Hg and a left ventricular e
jection fraction of 23%, Each-patient received 3 escalating doses of 1 mg,
2 mg, and 4 mg of levosimendan within 18-24 hours in an open-label pilot st
udy. After administration of a I-mg dose of levosimendan, PCWP decreased by
18% (p = 0.002) and cardiac output increased by 22% (p = 0.005), Diastolic
blood pressure was decreased by about 5 mm Hg, Plasma catecholamine levels
were unaffected, Plasma concentrations of levosimendan were unexpectedly l
ow after administration of the 2-mg dose, and responses were weak, This was
probably due to delayed drug absorption and altered baseline hemodynamics
caused by ingestion of a meal before drug intake. The 4-mg dose of levosime
ndan was associated with a 27% increase in cardiac output (p = 0.009). PCWP
showed only a small decrease, probably a result of relatively law baseline
values (carryover from previous doses). Right atrial pressure decreased su
bstantially by 40%, Heart rate increased by only 1-8 beats/min after admini
stration of the 1- and 4-mg doses of levosimendan, It is concluded that ora
l levosimendan has favorable cardiac and hemodynamic effects in patients wi
th severe CHF, and that these effects are similar to those seen after intra
venous dosing with levosimendan in this patient group. (C) 1999 by Excerpta
Medica, Inc.