Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-28T04:47:54.971Z Has data issue: false hasContentIssue false
  • English
  • Français

Levosimendan infusion improves haemodynamics in elderly heart failure patients undergoing urgent hip fracture repair

Published online by Cambridge University Press:  01 August 2008

M. Ponschab ,
N. Hochmair ,
N. Ghazwinian ,
T. Mueller  and
W. Plöchl
M. Ponschab*
Affiliation:
Trauma Hospital Linz, Department of Anaesthesiology and Intensive Care Medicine, Linz
N. Hochmair
Affiliation:
Trauma Hospital Linz, Department of Anaesthesiology and Intensive Care Medicine, Linz
N. Ghazwinian
Affiliation:
Trauma Hospital Linz, Department of Anaesthesiology and Intensive Care Medicine, Linz
T. Mueller
Affiliation:
Konventhospital Barmherzige Brueder, Department of Laboratory Medicine, Linz
W. Plöchl
Affiliation:
University of Vienna, Vienna General Hospital, Department of Anaesthesiology and General Intensive Care, Vienna, Austria
*
Correspondence to: Ponschab Martin, Department of Anaesthesiology and Intensive Care, Trauma Hospital Linz, Garnisonstraße 7, 4020 Linz, Austria. E-mail: [email protected]; Tel/Fax: +43 732 616202
Get access

Summary

Background

Elderly patients with heart failure undergoing urgent major surgery suffer substantial cardiac morbidity and mortality. Levosimendan, a novel calcium sensitizer, enhances myocardial contractility while simultaneously having vasodilatory and cardioprotective properties. This could be advantageous in perioperative management of heart failure patients.

Methods

Ten consecutive patients with symptomatic heart failure and left ventricular ejection fraction <35% undergoing urgent hip fracture repair were studied. Levosimendan was administered with an infusion rate of 0.1 μg kg−1 min−1 in a total dose of 12.5 mg starting a minimum of 2 h prior to surgery. Haemodynamic parameters were obtained at baseline and at 4, 8, 12, 16, 20, 24, 28, 36 and 48 h after start of levosimendan. B-type natriuretic peptide was measured on admission and after 48 h.

Results

Patients were 86 ± 7 yr (mean ± SD) of age. Levosimendan significantly increased cardiac index from 2.4 ± 0.3 L min−1 m−2 at baseline to 3.2 ± 0.6 L min−1 m−2 after 24 h by increases in stroke volume index (baseline 27 ± 5 mL m−2, after 24 h 37 ± 10 mL m−2, P < 0.05). Systemic vascular resistance index significantly decreased from 2718 ± 841 to 1964 ± 385 dyn s cm−5 m−2 within 24 h. Haemodynamic changes exerted by levosimendan persisted up to 48 h. B-type natriuretic peptide plasma concentrations decreased from 1143 ± 792 to 935 ± 724 ng L−1 after 48 h (P = 0.006).

Conclusion

In patients with heart failure, preoperative start of levosimendan infusion improves intraoperative and postoperative haemodynamics. These findings suggest that levosimendan is a useful drug for preoperative optimization of cardiac function in high-risk patients undergoing major surgery.

Keywords

SIMENDAN, levosimendanCARDIAC OUTPUTHIP FRACTURESSURGERY ORTHOPAEDICNATRIURETIC PEPTIDEBRAINCARDIOTONIC AGENTSHEART FAILURE
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 8 , August 2008 , pp. 627 - 633
Copyright
Copyright © European Society of Anaesthesiology 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Hernandez, A, Whellan, DJ, Stroud, S, Sun, JL, O`Connor, CM, Jollis, JG. Outcome in heart failure patients after major non cardiac surgery. J Am Coll Cardiol 2004; 44: 1446–1453.CrossRefGoogle Scholar
2.Roche, JJW, Wenn, RT, Sahota, O, Moran, CG. Effects of comorbidities and postoperative complications on mortality after hip fracture in elderly people: a prospective observational cohort study. BMJ 2005; 331: 1374–1379.CrossRefGoogle Scholar
3.Kontinen, N, Rosenberg, PH. Outcome after anaesthesia and emergency surgery in patients over 100 years old. Acta Anaesthesiol Scand 2006; 50: 283–289.CrossRefGoogle Scholar
4.Scoote, M, Williams, AJ. Myocardial calcium signalling and arrhythmia pathogenesis. Biochem Biophys Res Commun 2004; 322: 1286–1309.CrossRefGoogle ScholarPubMed
5.Thackray, S, Easthaugh, J, Freemantle, N, Cleland, JG. The effectiveness and relative effectiveness of intravenous drugs acting through the adrenergic pathway in patients with heart failure- a meta-regression analysis. Eur J Heart Fail 2002; 4: 515–529.CrossRefGoogle ScholarPubMed
6.Papp, Z, Csapo, K, Pollesello, P, Haikala, H, Edes, I. Pharmacological mechanism contributing to the clinical efficacy of levosimendan. Cardiovasc Drug Rev 2005; 23: 71–98.CrossRefGoogle Scholar
7.Sorsa, T, Heikkinen, S, Abott, MB et al. Binding of levosimendan, a calcium sensitizer, to cardiac troponin C. J Biol Chem 2001; 276: 9337–9343.CrossRefGoogle ScholarPubMed
8.Michaels, AD, McKeown, B, Kostal, M et al. Effects of intravenous levosimendan on human coronary vasomotor regulation, left ventricular wall stress, and myocardial oxygen uptake. Circulation 2005; 111: 1504–1509.CrossRefGoogle ScholarPubMed
9.Follath, F, Cleland, JG, Just, H et al. , Steering Committee and Investigators of the Levosimendan Infusion versus Dobutamine (LIDO) Study. Efficiacy and safety of intravenous levosimendan compared with dobutamine in severe low-output heart failure (The LIDO-Study): a randomised double-blind trial. Lancet 2002; 360: 196–202.CrossRefGoogle Scholar
10.Lilleberg, J, Nieminen, MS, Akkila, J et al. Effects of a new calcium sensitizer levosimendan on haemodynamics, coronary blood flow and myocardial substrate utilization early after CABG. Eur Heart J 1998; 19: 660–668.CrossRefGoogle Scholar
11.Pollesello, P, Mebazaa, A. ATP-dependent potassium channels as a key target for the treatment of myocardial and vascular dysfunction. Curr Opin Crit Care 2004; 10: 436–441.CrossRefGoogle ScholarPubMed
12.Slawsky, MT, Colucci, WS, Gottlieb, SS et al. Acute haemodynamic and clinical effects of levosimendan in patients with severe heart failure. Circulation 2000; 102: 2222–2227.CrossRefGoogle ScholarPubMed
13.Barisin, S, Husedzinovic, I, Sonicki, Z, Bradic, N, Barisin, A, Tonkovic, D. Levosimendan in off-pump coronary artery bypass. J Cardiovasc Pharmacol 2004; 44: 703–708.CrossRefGoogle ScholarPubMed
14.Nijhawan, N, Nikolosi, AC, Montgomery, MW, Aggarwal, A, Pagel, PS, Warltier, DC. Levosimendan enhances cardiac performance after cardiopulmonary bypass. J Cardiovasc Pharmacol 1999; 34: 219–228.CrossRefGoogle ScholarPubMed
15.Toufektian, L, Theodorou, D, Larentzakis, A, Misthos, P, Katsaragakis, S. Optimization of cardiac performance in chronic heart failure patients undergoing elective non-cardiac surgery. Curr Anaesth Crit Care 2007; 18: 50–57.CrossRefGoogle Scholar
16.Nieminen, MS, Böhm, M, Cowie, MR et al. ., ESC Committee for Practice Guideline (CPG). Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: the task force on acute heart failure of the European society of cardiology. Eur Heart J 2005; 26: 384–416.Google ScholarPubMed
17.Goldman, L, Caldera, DL, Nussbaum, SR et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med 1977; 297: 845–850.CrossRefGoogle ScholarPubMed
18.Lee, TH, Marcantonio, ER, Mangione, CM et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac procedures. Circulation 1999; 100: 1043–1049.CrossRefGoogle Scholar
19.Kersten, JR, Montgomery, MW, Pagel, PS, Warltier, DC. Levosimendan, a new positive inotropic drug, decreases myocardial infarct size via activation of K+(ATP) channels. Anaesth Analg 2000; 90: 5–11.CrossRefGoogle ScholarPubMed
20.Akao, M, Ohler, A, O’Rourke, B, Marban, E. Mitochondrial ATP-senstive potassium channels inhibit apoptosis induced by oxidative stress in cardiac cells. Circ Res 2001; 88: 1267–1275.CrossRefGoogle ScholarPubMed
21.Tritapepe, L, De Santis, V, Vitale, D et al. Preconditioning effects of levosimendan in coronary artery bypass grafting – a pilot study. Br J Anaesthesia 2006; 96: 694–700.CrossRefGoogle ScholarPubMed
22. Gibson SC, Payne CJ, Byrne DS, Berry C, Dargie HJ, Kingsmore DB. B-type natriuretic peptide predicts cardiac morbidity and mortality after major surgery. Br J Surg 2007; 94: 903–909.CrossRefGoogle Scholar
23.Avgeropoulou, C, Andreadou, I, Markantonis-Kyroudis, S et al. The Ca2+-sensitizer levosimendan improves oxidative damage, BNP and pro-inflammatory cytokine levels in patients with advanced decompensated heart failure in comparison to dobutamine. Eur J Heart Fail 2005; 7: 882–887.CrossRefGoogle ScholarPubMed