Cardiac, renal, and neurological benefits of preoperative levosimendan administration in patients with right ventricular dysfunction and pulmonary hypertension undergoing cardiac surgery: evaluation with two biomarkers neutrophil gelatinase-associated lipocalin and neuronal enolase

Figures & data

Table 1 Inotropic management (protocol)

Cardiac index	Cardiac index <2.4 L/min/m^2 and/or central venous oxygen saturation was <65% and wedge pressure >15 mmHg	Cardiac index <2.4 L/min/m^2 and/or central venous oxygen saturation was <65% and wedge pressure <15 mmHg
Systolic blood pressure >70 mmHg	Dobutamine (initial dose of 5 μg/kg/min)	Volume bolus (500 mL of Ringer’s solution)
Systolic blood pressure <70 mmHg	Adrenaline ± noradrenaline	Volume bolus (500 mL of Ringer’s solution)

Table 2 Patients’ preoperative epidemiological characteristics and surgical data

Sex (male/female)	14/13
Age (years)	67±8
Height (cm)	164±5
EuroScore	8±1
ASA class	III±1
Cleveland score	9±2
Type of surgery
Mitral	4/27
Aortic mitral	5/27
Mitral-tricuspid	13/27
Tricuspid	2/27
Aortic-mitral-tricuspid	3/27
Cardiopulmonary bypass time (min)	110±21
Time of ischemia (min)	74±12
Preoperative treatment
β-Blockers	15
ACE inhibitors/ARA II	12
Nitrates	5
Calcium antagonist blockers	4
Diuretics	21
Bronchodilating agents	14
Acetyl salicylic acid	6
Sildenafil/bosentan	18/27

Note: Data are given as absolute numbers or median ± SD.

Abbreviations: ASA, American Society of Anesthesiologists (physical status); min, minutes; ACE, angiotensin-converting enzyme; ARA, angiotensin receptor blockers; SD, standard deviation.

Table 3 Hemodynamic parameters

Hemodynamic parameters	Baseline		48 hours
	Mean ± SD	95% CI	Mean ± SD	95% CI
Tricuspid annulus diameter (mm)	4.23±0.7	3.5–5.8	3.05±0.6*	2.5–4.8
Heart rate (bpm)	70±9	65–78	71±7	70–80
Mean blood pressure (mmHg)	70±9	72–81	71±7	72–79
Central venous pressure (mmHg)	12±4	11–14	10±4	9–12
Pulmonary artery systolic pressure (mmHg)	58±19	31.17–48.89	42±18*	40–64.77

Note:

* Significant variations P<0.05.

Abbreviations: SD, standard deviation; CI, confidence interval.

Table 4 Biochemical and analytical parameters assessed during the study

Biochemical parameters	Baseline		2 hours after surgery		48 hours
	Mean ± SD or mean (SEM)	95% CI	Mean ± SD or mean (SEM)	95% CI	Mean ± SD or mean (SEM)	95% CI
Central venous saturation (%)	75±5	68–79	–	–	70±4	67–78
Lactate (mmol/L)	0.91±0.3	0.78–1.07	–	–	1.42±0.62	1.37–1.73
NT-ProBNP (pg/mL)	2,014 (79)	1,883–5,106*	–	–	3,456 (211)**	3,062–9,091
Creatinine (mg/dL)	1.06±0.24	1.04–1.44	–	–	1.25±0.37	1.22–1.68
N-GAL (ng/mL)	14.31 (28.34)	0.87–278.5	13.41 (38.24)	0.34–360.2	–	–
Neuron-specific enolase (ng/mL)	5.40 (0.41)	0.11–9.12	4.32 (0.61)	0.11–17.15	–	–

Notes:

* Significant variations (P<0.05).

** Value reported at 24 hours.

Abbreviations: N-GAL, neutrophil gelatinase-associated lipocalin; CI, confidence interval; SD, standard deviation; SEM, standard error of the mean.

Figure 1 Preoperative and postoperative N-GAL values.

Notes: The scatter graph shows N-GAL values before and after surgery in 27 patients preoperatively administered levosimendan and the mean of the N-GAL concentration in urine at these two time points. Preop was the preoperative values (before levosimendan) and postop was postoperative values (2 hours after ICU admission postsurgery). Mean values were 14.31 ng/mL prior to levosimendan infusion and 13.41 ng/mL 2 hours after ICU admission. The variations were not statistically significant (P>0.05).
Abbreviations: N-GAL, neutrophil gelatinase-associated lipocalin; ICU, intensive care unit.

Figure 2 Preoperative and postoperative neuron-specific enolase values.

Notes: The scatter graph shows neuron-specific enolase values before and after surgery in 27 patients preoperatively administered levosimendan and the medians of neuron-specific enolase concentrations in urine at these two time points. Preop was the preoperative values (before levosimendan) and postop was postoperative values (2 hours after ICU admission postsurgery). The median values were 5.4 ng/mL prior to levosimendan infusion and 4.32 ng/mL 2 hours after ICU admission. The variations were not statistically significant (P>0.05).
Abbreviation: ICU, intensive care unit.