Cor Vasa 2009, 51(7-8):507-512 | DOI: 10.33678/cor.2009.126

Levosimendan therapy in acute heart failure - experience from a specialized department of cardiology

Roman Miklík^*, Jiří Pařenica, Marian Felšöci, Martin Poloczek, Ondřej Toman, Jindřich Špinar, Tomáš Brychta

Interní kardiologická klinika, Fakultní nemocnice Brno a Lékařská fakulta Masarykovy univerzity, Brno, Česká republika

Introduction: Acute heart failure is a serious clinical condition with in-hospital and one-year mortality rates of 5-15% and 30%, respectively. The most common causes of acute heart failure include decompensated chronic coronary heart disease, acute coronary syndrome, cardiomyopathy, hypertensive crisis, arrhythmias, valvular defects, and others. Levosimendan has been used in our department since 2005. The drug has a dual mechanism of action, exerting both positive inotropic and lusitropic effects on the myocardium, and a vasodilator effect on the coronary and peripheral arteries. Levosimendan increases cardiac output and diuresis, decreases pulmonary wedge pressure, and improves the patient's mental state.
Aim and methods: To evaluate the profile of a patient with acute heart failure receiving levosimendan, the course of hospitalization, and the short- and long-term outcomes. Using standard statistical tests and Kaplan-Meier survival analysis, we analyzed patients' medical records, with mortality data obtained from the Institute of Health Information and Statistics of the Czech Republic or from hospital databases.

Results: In 2005-2007, levosimendan was used in 5.8% of patients with acute heart failure where conventional therapy with furosemide (100%) or/and nitrates (28.9%), despite frequent catecholamine support (68.8%), had failed to stabilize the patient. Those indicated for levosimendan therapy were mostly patients with acute coronary syndrome (36.0%) and decompensated chronic coronary heart disease (30.9%). Over the years, there was a decrease in the proportion of levosimendan-treated patients with de novo acute heart failure and acute coronary syndrome while the numbers of those with acutely decompensated heart failure and dilated cardiomyopathy increased. Mean infusion time was 28.8 (11-69) hours, with the frequency of administering an initial intravenous bolus declining to only 7% in 2007. Levosimendan infusion had to be discontinued prematurely in only 3.1% of patients. In-hospital and one-year mortality rates were 22.3% and 46.5%, respectively. There was no significant difference in mortality rates of patients with acutely decompensated heart failure, de novo acute heart failure, and acute coronary syndrome.

Conclusion: The authors present their three-year experience with levosimendan use. While the proportion of levosimendan-treated patients with acute coronary syndrome and de novo acute heart failure tended to decline over the years, the drug has been used preferentially in decompensated chronic heart failure. The one-year mortality rates in patients with de novo acute heart failure, acute heart failure decompensation, and in a selected subgroup of patients with acute heart failure do not differ significantly. If abiding by contraindications to levosimendan use, as discussed below, the authors believe levosimendan can be with reason and safely administered also to patients with acute coronary syndrome with de novo presentations of heart failure.

Keywords: Acute heart failure; Levosimendan; Mortality

Published: July 1, 2009  Show citation