Levosimendan in Acute Pulmonary Embolism

Revista Española de Cardiología (English Edition), 2007

Journal of clinical medicine research, 2014

Levosimendan, the active enantiomer of simendan, is a calcium sensitizer developed for treatment of decompensated heart failure, exerts its effects independently of the beta adrenergic receptor and seems beneficial in cases of severe, intractable heart failure. Levosimendan is usually administered as 24-h infusion, with or without a loading dose, but dosing needs adjustment in patients with severe liver or renal dysfunction. Despite several promising reports, the role of levosimendan in critical illness has not been thoroughly evaluated. Available evidence suggests that levosimendan is a safe treatment option in critically ill patients and may reduce mortality from cardiac failure. However, data from well-designed randomized controlled trials in critically ill patients are needed to validate or refute these preliminary conclusions. This literature review is an attempt to synthesize available evidence on the role and possible benefits of levosimendan in critically ill patients with s...

F1000Research, 2014

Cardiogenic shock (CS) is acute inadequate tissue perfusion caused by the heart's inability to pump an adequate amount of blood. Due to the failure of classic inotrope agents, a sensitizer agent, levosimendan, has been used as a rescue therapy in such situations. In order to assess the effectiveness of levosimendan to treat CS, we studied its hemodynamic effects on patients with CS. A retrospective study was conducted at the ICU of the Military Hospital of Tunis between January 2004 and December 2009, and between January 2011 and December 2013. Twenty-six patients with CS refractory to catecholamines were included in our study. When catecholamines failed to improve the hemodynamic condition, levosimendan was introduced. This treatment was administered in two steps: a loading dose of 12 µg/kg/min was infused for 30 min; and then continuous infusion was given for 24 h at a dose of 0.1 µg/kg/min. Levosimendan significantly increased mean arterial pressure to 76 ± 7 mmHg at 48 h and...

Kardiologia Polska

Levosimendan is a new inodilator which involves 3 main mechanisms: increases the calcium sensitivity of cardiomyocytes, acts as a vasodilator due to the opening of potassium channels, and has a cardioprotective effect. Levosimendan is mainly used in the treatment of acute decompensated heart failure (class IIb recommendation according to the European Society of Cardiology guidelines). However, numerous clinical trials indicate the validity of repeated infusions of levosimendan in patients with stable heart failure as a bridge therapy to heart transplantation, and in patients with accompanying right ventricular heart failure and pulmonary hypertension. Due to the complex mechanism of action, including the cardioprotective and anti aggregating effect, the use of levosimendan may be particularly beneficial in acute coronary syndromes, preventing the occurrence of acute heart failure. There are data indicating that levosimendan administered prior to cardiac surgery may improve outcomes in patients with severely impaired left ventricular function. The multidirectional mechanism of action also affects other organs and systems. The positive effect of levosimendan in the treatment of cardio renal and cardio hepatic syndromes has been shown. It has a safe and predictable profile of action, does not induce tolerance, and shows no adverse effects affecting patients survival or prognosis. However, with inconclusive results of previous studies, there is a need for a welldesigned multicenter randomized placebo controlled study, including an adequately large group of outpatients with chronic advanced systolic heart failure.

Jornal Brasileiro de Pneumologia, 2019

Revista Portuguesa De Cardiologia Orgao Oficial Da Sociedade Portuguesa De Cardiologia Portuguese Journal of Cardiology an Official Journal of the Portuguese Society of Cardiology, 2009

Journal of Cardiovascular Medicine, 2010

2004

Set temperature, 35°C AH (mgH 2 O/l) 26.7 ± 0.3* 37.4 ± 0.6 38.0 ± 0.9 RH (%) 83.7 ± 1.0* 97.7 ± 1.4 93.2 ± 1.5 Set temperature, 37°C AH (mgH 2 O/l) 34.5 ± 1.6* 38.7 ± 2.2 † 43.1 ± 1.1 RH (%) 91.8 ± 3.2 87.7 ± 7.4 † 94.6 ± 0.9 *P < 0.05 vs DAR HC and MR 730, † P < 0.05 vs MR 730.

Critical Care, 2019

Despite interesting and unique pharmacological properties, levosimendan has not proven a clear superiority to placebo in the patient populations that have been enrolled in the various recent multicenter randomized controlled trials. However, the pharmacodynamic effects of levosimendan are still considered potentially very useful in a number of specific situations.Patients with decompensated heart failure requiring inotropic support and receiving beta-blockers represent the most widely accepted indication. Repeated infusions of levosimendan are increasingly used to facilitate weaning from dobutamine and avoid prolonged hospitalizations in patients with end-stage heart failure, awaiting heart transplantation or left ventricular assist device implantation. New trials are under way to confirm or refute the potential usefulness of levosimendan to facilitate weaning from veno-arterial ECMO, to treat cardiogenic shock due to left or right ventricular failure because the current evidence is...

2021

Traditionally, the management of patients with pulmonary embolism has been accomplished with anticoagulant treatment with parenteral heparins and oral vitamin K antagonists. Although the administration of heparins and oral vitamin K antagonists still plays a role in pulmonary embolism management, the use of these therapies are limited due to other options now available. This is due to their toxicity profile, clearance limitations, and many interactions with other medications and nutrients. The emergence of direct oral anticoagulation therapies has led to more options now being available to manage pulmonary embolism in inpatient and outpatient settings conveniently. These oral therapeutic options have opened up opportunities for safe and effective pulmonary embolism management, as more evidence and research is now available about reversal agents and monitoring parameters. The evolution of the pharmacological management of pulmonary embolism has provided us with better understanding r...

Pharmaceuticals

Pulmonary thromboembolism is a very common cardiovascular disease, with a high mortality rate. Despite the clear guidelines, this disease still represents a great challenge both in diagnosis and treatment. The heterogeneous clinical picture, often without pathognomonic signs and symptoms, represents a huge differential diagnostic problem even for experienced doctors. The decisions surrounding this therapeutic regimen also represent a major dilemma in the group of patients who are hemodynamically stable at initial presentation and have signs of right ventricular (RV) dysfunction proven by echocardiography and positive biomarker values (pulmonary embolism of intermediate–high risk). Studies have shown conflicting results about the benefit of using fibrinolytic therapy in this group of patients until hemodynamic decompensation, due to the risk of major bleeding. The latest recommendations give preference to new oral anticoagulants (NOACs) compared to vitamin K antagonists (VKA), except...

European Heart Journal Supplements

Cardiovascular Therapeutics, 2015

Aims: To study the hemodynamic effect of levosimendan administration in acute heart failure patients with severe aortic stenosis (AS) and reduced left ventricular ejection fraction (LVEF). Methods: Hemodynamic response to 24 h intravenous levosimendan infusion (0.1 lg/kg/min without a loading dose) in patients with severe AS (aortic valve area ≤1 cm 2 , time-velocity integral between left ventricular out-flow tract and aortic valve <0.25), reduced LVEF (≤40%), and a depressed cardiac index (CI) <2.2 L/min/m 2 was determined in a sequential group of nine patients aged 76 AE 10 years (5 men). Results: Baseline mean ejection fraction was 33 AE 0.7%; mean aortic valve area was 0.37 AE 0.11 cm 2 /m 2 ; peak and mean gradients of 63.6 AE 20.53 and 36.7 AE 12.62 mmHg, respectively; and mean CI was 1.65 AE 0.20 L/min/m 2. At 6 and 12 h of levosimendan therapy, mean CI had increased to 2.00 AE 0.41 L/min/m 2 (P = 0.02) and 2.17 AE 0.40 L/min/m 2 (P = 0.01), respectively. At 24 h, mean CI had increased further to 2.37 AE 0.49 L/min/m 2 (P = 0.01). A significant beneficial effect was also observed in pulmonary capillary wedge pressure, pulmonary artery mean pressure, central venous pressure, systemic vascular resistances, pulmonary vascular resistances, stroke volume index, left ventricular stroke work index. NTproBNP levels decreased at 24 h of levosimendan treatment. Levosimendan infusion was also well tolerated. Five patients subsequently underwent aortic valve surgery replacement. One died (of postoperative multiorgan failure). At 30 days, overall survival was 75%. Conclusions: Levosimendan administration improves hemodynamic parameters in critically ill patients with severe AS and reduced LVEF. In our study, it provides a safe and effective bridge to aortic-valve replacement or oral vasodilator therapy in surgical contraindicated patients. A controlled study is needed to confirm these preliminary findings.

European heart journal. Acute cardiovascular care, 2012

Congestive heart failure and left ventricular dysfunction in the setting of severe aortic stenosis are associated with a high mortality rate. Evidence on optimal medical therapy is scanty. Vasodilators were traditionally considered to be contraindicated in severe aortic stenosis, albeit this concept has recently been challenged. The use of levosimendan, which has positive inotropic, vasodilatory and cardioprotective properties seems attractive. We describe a small series of exceedingly ill patients with severe aortic stenosis and left ventricular dysfunction, in different clinical settings (acute heart failure, cardiogenic shock and difficult-to-wean ventilatory support), in which levosimendan was successfully used.

Research Square (Research Square), 2024

Background and Aim: Using thrombolytics in intermediate-high risk pulmonary embolism (PE) patients or not is a controversial issue. This study aimed to evaluate the e cacy and complications of half-dose alteplase and low molecular weight heparin (LMWH) administration in PE patients with intermediate-high risk. Material and Methods: The patients diagnosed with intermediate-high risk PE at Ege University Medical Faculty Hospital between 01.01.2016-13.02.2023 were included in the study. The patients diagnosed with PE after the establishment of Ege Pulmonary Embolism Team (EGEPET) (2.10.2018) formed the prospective part with the thrombolytic group. The retrospective part-anticoagulation group-included the cases treated with LMWH before EGEPET. Two treatment groups were compared in terms of the onemonth mortality and the one-year mortality as primary outcomes. Results: No difference was found regarding the age, comorbidities and vital ndings between thrombolytic group and anticoagulation group. Only, the pulse value was higher in the thrombolytic group (p=0,032). After the treatment, the PaO 2 /FiO 2 ratio increased signi cantly, and the pulse rate decreased signi cantly in the thrombolytic group. Improvement was only seen in the pulse rate in the anticoagulation group. There was no major bleeding in both groups. One-month mortality in thrombolytic group was found in 4 patients (6.7%), while that was observed in 6 patients (15.8%) treated with LMWH (p=0,18). One-year mortality rates were 13.7% and 26.3% respectively (p=0,17). Conclusion: PaO 2 /FiO 2 ratio improved signi cantly and rapidly in patients treated with thrombolysis. Even one-month and one-year mortality rates were reduced in thrombolytic group, but this difference was not found statistically signi cant. Declarations Author Declarations Funding: The funding sources had no role in the design and conduct of the study; and also funding sources had no role in the collection, management, analysis, and interpretation of the data. Not any funding sources had used in this manuscript.