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Hemodynamic and cardiac peptide in septic myocardial depression: the effects of calcium sensitizer

Introduction

The aim of this retrospective study is to evaluate hemodynamic and neurohormonal effects of levosimendan in cardiac patients with sepsis-induced cardiac dysfunction. Septic shock is characterized by profound cardiovascular alterations including myocardial depression. Levosimendan has recently been shown to improve cardiac function in septic shock.

Methods

Fifteen patients with myocardial depression related to septic shock were enrolled. All patients had SIRS criteria, culture isolation of one or more pathogens, positive procalcitonin, SBP < 90 mmHg unresponsive to load challenge. We defined myocardial depression as a reduced SvO2 in the presence of increased brain natriuretic peptide secretion and Troponin I release, and systolic and/or diastolic dysfunction by transoesophageal echo evaluation of ejection fraction and mitral annulus tissue Doppler imaging velocities. All patients received levosimendan infusion for 24 hours at 0.1 μg/kg/min combined with norepinephrine.

Results

Data were obtained by evaluating the average of the percentage variation between T0 (starting infusion) and T1 (24 hours after infusion), T2 (48 hours), T3 (72 hours), T4 (96 hours), T5 (120 hours) and T6 (144 hours). Levosimendan significantly increased SvO2 and ejection fraction, and decreased Troponin I and brain natriuretic peptide. Levosimendan improved diastolic function by increasing the E' velocity at tissue Doppler imaging at 48 hours. All data were analysed by the Fisher F test.

Conclusion

Levosimendan seems to improve systemic hemodynamics and neurohormonal cardiac function in patients with septic cardiac dysfunction.

Table 1 abstract P38

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Cariello, C., Guarracino, F., Giannecchini, L. et al. Hemodynamic and cardiac peptide in septic myocardial depression: the effects of calcium sensitizer. Crit Care 11, P39 (2007). https://0-doi-org.brum.beds.ac.uk/10.1186/cc5199

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Keywords

  • Septic Shock
  • Brain Natriuretic Peptide
  • Procalcitonin
  • Tissue Doppler Imaging
  • Levosimendan