The effect of Levoisimendan on the D-dimer level in chronic atrial fibrillation cases with cardiac failure

Abstract

We determined the short-term effects of Levoisimendan, on the D-dimer level in patient’s decompensated heart failure (HF) with non valvular atrial fibrillation (NVAF). The study population consisted of 62 chronic HF patients (24 women and 38 men, mean age: 67.5 ±16.5 years) with New York heart association (NYHA) III-IV and a left ventricular ejection fraction (EF) lower than 35%. Patients were divided into two groups, group I (sinus rhythm, 38 patients) and Group II (chronic NVAF, 24 patients). A loading dose of Levoisimendan (12 μg/kg) was administered over 10 min, followed by an infusion (0.1 μg/kg per minute) for 50 min in all patients, the rate was increased to 0.2 μg/kg per minute for an additional 23 h as tolerated. Plasma cardiac D-Dimer levels were measured at pre-treatment period and 5 days after treatment. Demographic variables were similar in both groups. The difference in hemodynamic parameters was not significant with respect to arterial systolic blood pressure and heart rate. However, diastolic blood pressure was significantly low in the NVAF group (p = 0.008). As for biochemical parameters, while there was no difference in baseline creatinine, serum sodium(Na), serum potassium (K), uric acid (UA) and blood urea nitrogen (BUN) value was detected to be higher in the atrial fibrillation (AF) group (p = 0.03). The left ventricular ejection fraction was 26.6 ± 5.5 and 29.2 ± 5.0% in the group with and without NVAF, respectively, no difference was observed (p > 0.05). The D-dimer levels in the NVAF group were upper than sinus rhythm groups (p > 0.05).However, there was no statistically significant difference between the pre-infusion and post-infusion values of d-dimer 1749 vs 1824 ng/ml, p = 0.69. Furthermore, plasma D-dimer levels increased after Levoisimendan infusion, but D-dimer levels showed non significant correlation with atrial fibrillation group. The clinical improvement as reflected in the patients’ NYHA classification was found to be higher in the sinus rhythm group than in NVAF group (p = 0.045). No relationship was found between the NYHA class and the D-dimer levels (p > 0.05) both in general and within the treatment groups. The results of our study show that the effect of Levoisimendan on both clinical response and thrombogenicity is limited compared to sinus rhythm in decompensated HF patients with NVAF in the acute period. Further studies are required to evaluate the results of this association in the long-term. Key words: Levoisimendan, atrial fibrillation, heart failure, D-dimer.