Early and sustained haemodynamic improvement with levosimendan compared to intraaortic balloon counterpulsation (IABP) in cardiogenic shock complicating acute myocardial infarction

Abstract

Objective: To investigate the haemodynamic effects of levosimendan in patients with cardiogenic shock (CS) complicating acute myocardial infarction in comparison to the effects of intra‐aortic balloon counterpulsation (IABP). Methods: 10 patients with intractable CS under standard therapy (including the use of PCI, inotropes, and vasopressors) received i.v. infusion of levosimendan (bolus 12 µg/kg i.v., followed by continuous infusion 0.1 µg/kg/min for 24 h). Haemodynamic effects were compared to the effects of IABP‐placement added to standard care in 12 patients with CS. Results: Within 24 h, both levosimendan and IABP produced a significant increase in cardiac index (CI) and cardiac power index and a decrease in systemic vascular resistance (SVR) (CI [l/min/m2] baseline 1.97±0.15, at 24 h 2.82±0.22 for levosimendan; baseline 1.98±0.17, at 24 h 2.66±0.08 for IABP; SVR [dyn*s*cm–5] baseline 1353±106, at 24 h 846±69 for levosimendan; baseline 1311±214, at 24 h 853±63 for IABP, respectively). After 3 h of treatment, CI and SVR had significantly improved in patients treated with levosimendan but not in the IABP‐group (CI [l/min/m2] at 3 h 2.72±0.28 (+38%) for levosimendan versus 2.18±0.15 (+10%) for IABP). Conclusion: Infusion of levosimendan in acute CS results in early and sustained haemodynamic improvement. Short‐term haemodynamic effects compare favourably with those seen after invasive IABP placement.

• Inotropic agents
• shock
• myocardial infarction
• levosimendan
• IABP
• acute myocardial infarction