Background: Levosimendan is a Ca²⁺-sensitizer with inodilator action able to improve cardiac contractility without increse oxygen demand. In AHF setting clinical trial and registries showed an improvement in systemic haemodynamics without a decrease in in-hospital mortality.
Purpose: evaluate safety and efficacy of Levosimendan in an ischemic CS population.
Methods: All consecutive patients with CS after AMI admitted at our CICU from March 2012 to July 2021 were included in this single-centre retrospective study. 39 patients received Levosimendan alone or in combination with other inotropic drugs. All patients had an invasive monitoring of arterial pressure and continuous ECG-monitoring. Patients with severe renal failure were excluded. An echocardiogram was performed before drug infusion and 3 days after. We collected data from haemodynamics and from ECG monitoring looking for arrhythmic events.
Results: We enrolled 167 patients with CS after AMI, 39 patients received Levosimendan and 10 of them required association with low-dosage noradrenaline. 32 received Levosimendan at dosage of 0,1 mcg/kg/min. The drug was started on average 4 days after hospitalization. Statistical analysis showed a significant change in left ventricular EF assessed by echocardiogram from 25% to 31% (P = 0.018, fig 1). We observed also an improvement of symptoms with an overall relief of dyspnea and fatigue clinically evaluated. The ECG monitoring showed ventricular arrhythmias (VA) in 11 patients (NSVT, SVT, VF) but the most frequent arrhythmia after Levosimendan was atrial fibrillation (AF) which was significantly associated with in-hospital mortality (OR = 1,82, p = 0,002), whereas VA did not. Moreover patients with new onset AF after Levosimendan showed a lower clinical and instrumental response to the drug. No significant changes in electrolytes (sodium and potassium) have been documented during arrhythmic events.
Conclusion: Levosimendan is useful in CS after AMI setting because has demonstrated to improve systemic hemodynamics parameters and symptomatology. Overall Levosimendan is safe with a low rate of ventricular arrhythmias that, in our sample, are not associated with in-hospital mortality. Moreover we observed also a significant increase in AF that was associated with in-hospital mortality, but further studies in larger populations could be advisable to describe the real incidence of AF after Levosimendan infusion and its prognostic role in CS patients.