Abstract 2057: Effects Of Levosimendan On Microcirculation In Patients With Cardiogenic Shock

Abstract

Introduction: Cardiogenic shock is characterized by low cardiac output and reduced perfusion pressure with subsequent disturbance of microcirculation. OPS vessel microscopy (orthogonal polarized spectral imaging) is a new method to visualize microcirculation. Methods: In this study 20 Patients with severe cardiogenic shock caused by a myocardial infarction were followed three days after PCI. Group 1 got the conventional catecholamine treatment (norepinephrine and/or dobutamine), and Group 2 received in addition to this common therapy the calcium sensitizer Levosimendan (Simdax®). Five areas in the oral vestibule were recorded and averaged each 24 hours for three days. Data were transferred on a PC and analysed: The average of diameters, of flow and the cell blood velocity (CBV) were recorded. In this way the effects of Levosimendan on microcirculation were observed. Results: An increase of the microcirculatory parameters was observed together with a progressing heart index (HI = 2.4 l/min/m2 on day 1 to HI = 3.5 l/min/m2 on day 3): the averaged vessel diameters went up significantly, also the average flow (p<0.028). In patients treated with Levosimendan microcirculation showed 24 hour infusion an increase in vessel diameters after Levosimendan (27.6 μm to 37.1 μm; p=0.013) as well as an improved flow (387x10 –9ml/s to 1049x10 –9ml/s; p=0.047). CBV also augmented in tendency (480 μm/s to 737 μm/s; p=0.054). Compared to conventionally treated patients, we observed a higher vessel diameter in the Levosimendan treated patients(27,37 μm vs. 34,65 μm; p=0,039) Conclusion: Our data may suggest a benefit for the organ perfusion under Levosimendan treatment. OPS technology could become a new tool to follow shock patients on the intensive care unit in order to analyze therapeutic drug effects on microcirculation.