• Martin A Russ, Roland Prondzinsky, Arnd Christoph, Axel Schlitt, Ute Buerke, Gerold Söffker, Henning Lemm, Michael Swyter, Nikolas Wegener, Matthias Winkler, Justin M Carter, Sebastian Reith, Karl Werdan, and Michael Buerke.
• Department of Internal Medicine III, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany.
• Crit. Care Med. 2007 Dec 1;35(12):2732-9.

ObjectivesLevosimendan, a novel inodilator, has been shown to improve hemodynamic function in patients with acute exacerbation of congestive heart failure. We wanted to determine the hemodynamic effects of levosimendan following ineffective conventional therapy (with catecholamines) in patients with cardiogenic shock following myocardial infarction.DesignObservational hemodynamic study.SettingTertiary care center university hospital.PatientsFifty-six patients with cardiogenic shock secondary to myocardial infarction were treated with percutaneous revascularization (intra-aortic balloon pump where appropriate) and commenced on conventional inotropic therapy.InterventionsPatients with persisting cardiogenic shock 24 hrs after revascularization were additionally treated with levosimendan (rapid bolus of 12 microg/kg for 10 mins, then 0.05-0.2 mug/kg/min for 24 hrs) (n = 25).Measurements And Main ResultsWith conventional catecholamine therapy (norepinephrine and dobutamine), we observed only marginal improvement in mean arterial pressure or cardiac index. In contrast, the addition of levosimendan produced a significant increase in cardiac index (2.1 +/- 0.56 to 3.0 +/- 1.11 L/min/m2, p < .01) and cardiac power index (0.32 +/- 0.08 to 0.44 +/- 0.18 W, p < .01), whereas systemic vascular resistance decreased significantly (1208 +/- 333 to 858 +/- 299 dyne.sec.cm(-5), p < .01). There was no significant change in blood pressure during levosimendan treatment. Hemodynamic improvement was sustained after levosimendan infusion was stopped.ConclusionsLevosimendan infusion in cardiogenic shock following acute myocardial infarction improved cardiovascular hemodynamics without leading to hypotension.

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