Abstract
The beneficial effects exerted by levosimendan against cardiac failure could be related to the modulation of oxidative balance. We aimed to examine the effects of levosimendan in patients with cardiogenic shock or low cardiac output on cardiac systo-diastolic function and plasma oxidants/antioxidants (glutathione, GSH; thiobarbituric acid reactive substances, TBARS). In four patients undergoing coronary artery bypass grafting or angioplasty, cardiovascular parameters and plasma GSH and TBARS were measured at T0 (before levosimendan infusion), T1 (1 h after the achievement of the therapeutic dosage of levosimendan), T2 (end of levosimendan infusion), T3 (72 h after the end of levosimendan infusion), and T4 (end of cardiogenic shock). We found an improvement in the indices of systolic (ejection fraction, cardiac output, cardiac index) and diastolic (E to early diastolic mitral annular tissue velocity, E/’; early to late diastolic transmitral flow velocity, EA) cardiac function at early T2. A reduction of central venous pressure and pulmonary wedge pressure was also observed. Plasma levels of GSH and TBARS were restored by levosimendan at T1, as well. The results obtained indicate that levosimendan administration can regulate oxidant/antioxidant balance as an early effect in cardiogenic shock/low cardiac output patients. Modulation of oxidative status on a mitochondrial level could thus play a role in exerting the cardio-protection exerted by levosimendan in these patients.
Highlights
Levosimendan is an inotrope used for the treatment of acutely decompensated heart failure patients with low cardiac output or cardiogenic shock [1,2,3,4].Among its mechanisms of action, the sensitization of cardiac troponin C to calcium in cardiac muscle [5,6,7] and the opening adenosine triphosphate-sensitive potassium (KATP) channels in vascular smooth muscle cells [8,9] have been described
In the present study, we aimed to examine, at the same time, the effects of intravenous levosimendan treatment on (1) systolic and diastolic functions, (2) hemodynamic variables, and (3) oxidant/antioxidant systems, in patients admitted to the cardiothoracic intensive care unit (ICU) for cardiogenic shock or decompensated heart failure after coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA)
Improvements were recorded in cardiac output (CO), cardiac index (CI), and SAP, as shown in Figures 1 and 2A,B
Summary
Among its mechanisms of action, the sensitization of cardiac troponin C to calcium in cardiac muscle [5,6,7] and the opening adenosine triphosphate-sensitive potassium (KATP) channels in vascular smooth muscle cells [8,9] have been described. Due to these pharmacological actions, levosimendan improves atrio-ventricular coupling and cardiac mechanical efficiency without increasing myocardial oxygen consumption [10,11,12,13]. Similar nominally beneficial effects against peroxidation were observed in anesthetized rats subjected to hepatic ischemia/reperfusion and treated with levosimendan [21]
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