Effects of levosimendan on coronary artery flow and cardiac performance in patients with advanced heart failure

Background: Levosimendan has inotropic and vasodilatory effects. We investigated the effects of levosimendan on coronary flow and associated changes in neurohormonal activation and cardiac performance in patients with advanced heart failure. Methods: Forty-two patients with NYHA III-IV and a left ventricular ejection fraction (EF) 25 +/- 6%, were randomised to levosimendan 0.1 mu g/kg/min (n=21) or placebo for 24 It. Before and 24 h after each treatment, we assessed: the maximal velocity (Vmax), time integral (VTI) and deceleration time (DT) of the diastolic coronary flow wave (CF) in LAD using transthoracic Doppler echocardiography, pulmonary artery systolic pressure by Doppler echocardiography, E/E' ratio using Doppler imaging of mitral inflow velocity, tissue Doppler imaging of the mitral annulus and B-type natriuretic peptide (BNP) levels. Results: By ANOVA, there was a greater increase in CF-Vmax (43 +/- 23 vs.25 +/- 8 cm/s), CF-DT (904 +/- 250 vs. 667 +/- 151 ms), and EF and a greater decrease in BNP, pulmonary artery systolic pressure and E/E' after levosimendan than after placebo (P < 0.05). Compared to baseline, the percent changes in CF-VTI were related to the concomitant changes in EF, E/E', and BNP after treatment with levosimendan (r=0.69, r=-0.51 and r=-0.80,p < 0.05 respectively). Conclusion: Treatment with levosimendan improves coronary flow and microcirculation in parallel with an improvement in cardiac performance and neurohormonal activation in patients with advanced heart failure. (c) 2007 European Society of Cardiology. Published by Elsevier B.V All rights reserved.