Effect of levosimendan on myocardial performance and arrhythmia in patients with advanced heart failure

Objective: The calcium sensitizer levosimendan is one of the best documented pharmacological agents used in the management of advanced heart failure syndromes. It improves cardiac performance, but It’s effect on arrhythmia development is not investigated well. The aim of this study was to determine the inotropic effect of levosimendan and its duration and to investigate whether it caused arrhythmia.
Methods: Twenty-four patients (in sinus rhythm) with stage III-IV heart failure were enrolled in the study. Brain natriuretic peptide (BNP), echocardiography, 24-hour rhythm Holter, heart rate variability analysis (HRV), signal-averaged ECG were performed. These tests were repeated on days 1, 15 (BNP and echocardiography only), and 28 following levosimendan infusion therapy.
Results: Brain natriuretic peptide level was reduced on day 1. and increased on days 15. and 28. left ventricular ejection fraction was increased significantly on the first day and reduced on days 15 and 28, however the difference remained significant. Reduction of miyocardial performance index (Tei Ýndex) was significantly on the first day. Late potential positivity was found in 7 patients at the baseline. After treatment it was found in 5 patients on Day 1 and in 8 patients on day 28. Regarding atrial fibrillation, no difference was found compared to the baseline. Standard deviation of all normal RR intervals (SDNN) and Standard deviation of average NN (RR) intervals (SDANN) increased significantly
on day 28.
Conclusion: Levosimendan increases left ventricular performance and does not have an effect on arrhythmia development and provides partial improvement in HRV analysis.

Ýleri kalp yetmezliði olan hastalarda levosimendanýn miyokart performansý ve aritmi üzerindeki etkisi

Amaç: Kalsiyum duyarlaþtýrýcý ajanlardan olan levosimendan ileri kalp yetmezliði tedavisinde kullanýlan farmakolojik ajanlardan biridir. Kardiyak performansý arttýrdýðý bilinmekte ancak aritmi geliþimi üzerine etkisi iyi bilinmemektedir. Bizim çalýþmamýzýn amacý levosimendanýn inotropik etkisi ve süresini saptamak ve aritmiye neden olup olmadýðýný araþtýrmaktýr.
Yöntem: Evre III-IV kalp yetmezliði olan sinüs ritmindeki 24 hasta çalýþmaya alýndý. Beyin natriüretik peptid (BNP), ekokardiyografi (EKO), 24 saatlik ritim Holter, kalp hýzý deðiþkenliðinin (KHD) analizi, sinyal ortalamalý EKG yapýldý. Levosimendan infüzyonu öncesi ve sonrasý [1, 15 (BNP ve EKO sadece), 28’inci günlerinde] bu testler tekrarlandý.
Bulgular: BNP düzeyleri baþlangýca göre 1. günde azaldý; 15 ve 28. günlerde arttý. Sol ventrikül ejeksiyon fraksiyon’u ilk gününde önemli ölçüde arttý; 15 ve 28. günlerde azaldý ve bu deðiþim istatistiki olarak anlamlý bulundu. Miyokardiyal performans indeksinin (Tei Ýndeksi) deðeri anlamlý olarak ilk günde azaldý. Geç potansiyel pozitifliði baþlangýçta 7 hastada tespit edildi. Tedavi sonrasýndaki 1. günde 5 ve 28. günde 8 hastada tespit edildi. Atriyal fibrilasyon ile ilgili olarak, baþlangýca göre tedavi sonrasý anlamlý artýþ tespit edilmedi. 28 gün de RR sürelerinin standart sapmasý (SDNN) ve ortalama RR sürelerinin standart sapmasý (SDANN) deðerlerinde anlamlý ölçüde artýþ saptandý.
Sonuç: Levosimendanýn sol ventrikül performansýný arttýran ve KHD analizlerinde kismi düzelme saðlayan etkisi vardýr aritmi geliþimini arttýrýcý etkisi yoktur.