Levosimendana em pacientes com insuficiência cardíaca descompensada: eficácia em uma coorte brasileira. Resultados do estudo BELIEF

Bocchi, Edimar Alcides; Vilas-Boas, Fábio; Moreira, Maria da Consolação Vieira; Barretto, Antônio Carlos Pereira; Lage, Silvia G.; Albuquerque, Denílson Campos de; Baima, Jader; Rassi, Salvador; Ribeiro, Jorge Pinto

doi:10.1590/s0066-782x2008000300008

Cited by 13 publications

(6 citation statements)

References 33 publications

(38 reference statements)

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“…According to Antila et al [ 44 ] levosimendan has a rapid onset time (< 30 minutes). The BELIEF study [ 45 ] demonstrated no difference in inotropic action of levosimendan when it was used continuously or as a bolus. In this study, we used continuous infusion of both drugs without a loading dose.…”

Section: Discussionmentioning

confidence: 99%

A Randomized Blinded Study of the Left Ventricular Myocardial Performance Index Comparing Epinephrine to Levosimendan following Cardiopulmonary Bypass

Filho

Barral²,

Barrucand

et al. 2015

PLoS ONE

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BackgroundThe objective was to evaluate the effect of epinephrine and levosimendan on the left ventricle myocardial performance index in patients undergoing on-pump coronary artery by-pass grafting (CABG).MethodsIn a double-blind, randomized clinical trial, 81 patients (age: 45–65 years) of both genders were randomly divided to receive either epinephrine at a dosage of 0.06 mcg.kg1.min-1 (epinephrine group, 39 patients) or levosimendan at 0.2 mcg.kg1.min-1 (levosimendan group, 42 patients) during the rewarming of cardiopulmonary by-pass (CPB). Hemodynamic data were collected 30 minutes after tracheal intubation, before chest open (pre-CPB) and 10 minutes after termination of protamine (post-CPB). As the primary outcome, we evaluated the left ventricle myocardial performance index by the Doppler echocardiography. The myocardial performance index is the sum of the isovolumetric contraction time and the isovolumetric relaxation time, divided by the ejection time. Secondary outcomes were systolic and diastolic evaluations of the left ventricle and postoperative troponin I and MB-CK levels.ResultsOf the 81 patients allocated to the research, we excluded 2 patients in the epinephrine group and 6 patients in the levosimendan group because they didn’t wean from CPB in the first attempt. There was no statistical difference between the groups in terms of patient characteristics, risk factors, or CPB time. The epinephrine group had a lower left ventricle myocardial performance index (p = 0.0013), higher cardiac index (p = 0.03), lower systemic vascular resistance index (p = 0.01), and higher heart rate (p = 0.04) than the levosimendan group at the post-CPB period. There were no differences between the groups in diastolic dysfunction. The epinephrine group showed higher incidence of weaning from CPB in the first attempt (95% vs 85%, p = 0.0001) when compared to the levosimendan group and the norepinephrine requirement was higher in the levosimenandan group than epinephrine group (16% vs. 47%; p = 0.005) in post-CPB period. Twenty-four hours after surgery, the plasma levels of troponin I (epinephrine group: 4.5 ± 5.7 vs. levosimendan group: 2.5 ± 3.2 g/dl; p = 0.09) and MB-CK (epinephrine group: 50.7 ± 31 vs. levosimendan group: 37 ± 17.6 g/dl; p = 0.08) were not significantly different between the two groups.ConclusionWhen compared to levosimendan, patients treated with epinephrine had a lower left ventricle myocardial performance index in the immediate post-CPB period, encouraging an efficient weaning from CPB in patients undergoing on-pump CABG.Trial RegistrationClinicalTrials.gov NCT01616069

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Section: Discussionmentioning

confidence: 99%

A Randomized Blinded Study of the Left Ventricular Myocardial Performance Index Comparing Epinephrine to Levosimendan following Cardiopulmonary Bypass

Filho

Barral²,

Barrucand

et al. 2015

PLoS ONE

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“…A Brazilian cohort32 including 182 high risk patients with decompensated HF received open label levosimendan infusions added to a baseline treatment with diuretics, ACE inhibitors/angiotensin receptor antagonists and beta-blockers. In 39% inotropic agents were already used before without success.…”

Section: Levosimendan In Routine Clinical Practicementioning

confidence: 99%

Newer treatments for decompensated heart failure: focus on levosimendan

Folláth¹

2009

DDDT

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Acute heart failure (AHF) is a major cause of hospitalizations. Severe dyspnea, pulmonary congestion and low cardiac output with peripheral vasoconstriction and renal hypoperfusion is a main form of clinical presentation. Most patients with acute worsening have a pre-existing decompensated chronic heart failure (ADCHF), but AHF may also occur as a first manifestation of a previously unknown heart disease. Myocardial ischemia, cardiac arrhythmias, non-compliance with medication and infections are frequent precipitating factors. Management of AHF depends on the underlying heart disease and cause of decompensation. In patients with ADCHF vasodilators and iv diuretics are first-line drugs for rapid reduction of dyspnea and congestion. In patients with signs of low cardiac output and oliguria, inotropic agents are also often administered to prevent further deterioration. Beta-adrenergic agents and phosphodiesterase inhibitors correct the hemodynamic disturbance, but may also induce arrhythmias and worsen myocardial ischemia. Inotropic therapy therefore remains controversial. A novel class of drugs, the calcium sensitizers, represent a new therapeutic option. Levosimendan was shown to improve myocardial contractility without increasing oxygen requirements and to produce peripheral and coronary vasodilation. Its therapeutic effects and tolerance have been tested in several trials. The present review focuses on the clinical pharmacology and therapeutic utility of levosimendan in patients with ADCHF.

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“…A limitation of the BELIEF study 8 is its observational nature without a comparative treatment group not using levosimendan. Although similar positive results during routine clinical use have been reported in a multicenter postmarketing study in Portugal 10 , the disappointing outcome of the recently published SURVIVE trial 11 will reduce the acceptance of levosimendan in those centers having no or only little experience with the drug.…”

mentioning

confidence: 99%

Podemos acreditar na levosimendana?

Folláth¹

2008

Arq. Bras. Cardiol.

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Levosimendana em pacientes com insuficiência cardíaca descompensada: eficácia em uma coorte brasileira. Resultados do estudo BELIEF

Abstract: Our results suggest levosimendan infusion as an alternative therapy in the short term management of DHF patients. HF severity can influence the response to levosimendan treatment. Prospective studies are warranted in a Brazilian cohort including Chagas heart disease.

Cited by 13 publications

References 33 publications

A Randomized Blinded Study of the Left Ventricular Myocardial Performance Index Comparing Epinephrine to Levosimendan following Cardiopulmonary Bypass

A Randomized Blinded Study of the Left Ventricular Myocardial Performance Index Comparing Epinephrine to Levosimendan following Cardiopulmonary Bypass

Newer treatments for decompensated heart failure: focus on levosimendan

Podemos acreditar na levosimendana?

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