Evaluation of ventriculo-arterial coupling in ST elevation myocardial infarction with left ventricular dysfunction treated with levosimendan.
Int J Cardiol
; 288: 1-4, 2019 08 01.
Article
en En
| MEDLINE
| ID: mdl-31056414
BACKGROUND: Acute heart failure (AHF) after ST-segment elevation myocardial infarction (STEMI) is usually treated with inotropic support or vasoactive medications. In this study, we aimed at investigating the role of levosimendan on cardiovascular determinants of contractility and afterload in patients with AHF following STEMI treated with percutaneous coronary intervention (PCI). METHODS: Forty-eight consecutive STEMI patients were retrospectively enrolled. Non-invasive assessment of left ventricular elastance (Ees) and arterial elastance (Ea) and their relationship, ventriculo-arterial coupling (VAC) was performed before and after levosimendan infusion. RESULTS: After infusion of levosimendan a significant increase in SV was detected in all patients (from 48⯱â¯17 to 60⯱â¯21â¯ml, pâ¯<â¯0.001). VAC slightly decreased from 1.74⯱â¯0.8 to 1.66⯱â¯0.7 (pâ¯=â¯NS) as a result of a profound reduction in arterial elastance (Ea 2.34⯱â¯1.09 to 1.74⯱â¯0.5â¯mmâ¯Hg/ml, pâ¯<â¯0.001) and in ventricular elastance (Ees 1.57⯱â¯0.12 to 1.24⯱â¯0.09â¯mmâ¯Hg/ml, pâ¯=â¯0.021). Ejection fraction (EF) (from 0.29⯱â¯0.1 to 0.32⯱â¯0.1, pâ¯<â¯0.01) and WMSI, (from 2.16⯱â¯0.47 to 2.05⯱â¯0.54, pâ¯<â¯0.05) also, significantly improved. Finally, baseline VAC was able to predict the use of norepinephrine (NE) and early and one-year mortality of patients treated. CONCLUSION: In STEMI patients with AHF the use of levosimendan significantly increases stroke volume after 24-hour treatment through Ea reduction. Baseline VAC seemed to predict early and late mortality and early and prolonged use of NE, however, this needs to be tested in larger series of patients and multivariate adjustments for other prognostic predictors.
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Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Aorta Torácica
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Volumen Sistólico
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Disfunción Ventricular Izquierda
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Infarto del Miocardio con Elevación del ST
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Simendán
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Ventrículos Cardíacos
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Contracción Miocárdica
Tipo de estudio:
Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Int J Cardiol
Año:
2019
Tipo del documento:
Article
Pais de publicación:
Países Bajos