Short-term clinical efficacy and safety of levosimendan in patients with cardiogenic shock

Abstract

Objective To evaluate the short-term clinical efficacy and safety of levosimendan in patients with cardiogenic shock (CS). Methods Patients hospitalized with CS in cardiac care unit of TEDA International Cardiovascular Hospital from March 2016 to November 2018 were enrolled and divided into control group (conventional therapy) and levosimendan group (conventional therapy plus intravenous levosimendan for 24 h). The cardiac index (CI) and pulmonary capillary wedge pressure (PCWP) were detected by Swan-Ganz catheterization. The changes of CI, PCWP, heart rate (HR) and mean artery pressure (MAP) were observed before treatment and 6 h, 12 h, 24 h, 48 h and 72 h after treatment. Left ventricular ejection fraction (LVEF) and left ventricle end-diastolic diameter (LVDD) detected by echocardiography and B-type natriuretic peptide (BNP) before and 48-72 h after treatment were compared. Arterial blood lactate level was measured before and 24 h after treatment to calculate the 24 h clearance rate. The length of stay (LOS) in hospital, the occurrence of major complications (bleeding, arrhythmia and infection) during hospitalization and in-hospital mortality were compared between these two groups. Kaplan-Meier curve was used to compare the 30d and 90d survival rate with log-rank test between these two groups. Results A total of 74 patients with CS was enrolled, of which 38 in levosimendan group and other 36 in control group. There was a significant increase in CI and decrease in PCWP after treatment for both groups (all P 0.05). LVEF increased and BNP decreased significantly at 48-72 h after treatment for both groups with higher LVEF [(35.4±5.1)% vs. (31.7±5.2)%] and lower BNP [(1 025.4±519.1) pg/ml vs. (1 454.1±659.2) pg/ml] in levosimendan group than control group (both P 0.05). The 30 d survival rate was not significantly different between these two groups (P>0.05), and there was a lower trend in the 90 d survival rate for levosimendan group compared to control group (P=0.069). Conclusion Levosimendan can improve hemodynamic status, cardiac function and reduce the blood lactate level in patients with CS with good safety. It does not improve the hospital mortality and 30 d survival rate, but has the trend in reducing 90 d survival rate. Key words: Cardiogenic shock; Levosimendan; Efficacy; Safety