Acute effects of levosimendan on mitral regurgitation and diastolic function in patients with advanced chronic heart failure

BACKGROUND: We analyzed the inodilator properties of levosimendan in patients with chronic heart failure and severe functional mitral regurgitation. METHODS: We studied 20 patients under optimal treatment and in stable clinical condition (New York Heart Association 3.19 ± 0.66; 70 ± 7 years). Levosimendan was infused as a bolus (12 μg/kg in 10 min) followed by a 24-h infusion (0.1-0.2 μg/kg per min). Before and after infusion, Doppler echocardiography, brain natriuretic peptide determination and noninvasive hemodynamic monitoring with bioimpedance cardiography were performed. RESULTS: Levosimendan improved left ventricular ejection fraction (ejection fraction 31 ± 4 from 27 ± 4, P < 0.05), decreased brain natriuretic peptide (333 ± 139 from 629 ± 63 pg/ml, P < 0.01), reduced mitral valve effective regurgitant orifice area to 27 ± 5 from 36 ± 7 mm (P < 0.01) and the velocity of displacement of mitral annulus [ratio between E and E′ waves on Doppler and tissue Doppler (E/E′) from 22.7 ± 1.6 to 13.1 ± 0.6, P < 0.01]. Noninvasive hemodynamic monitoring showed increased acceleration index (a marker of inotropism), and reduced peripheral resistances and thoracic fluid content (P < 0.01). After 4 weeks of washout, some of these effects were still evident. CONCLUSION: In patients with chronic heart failure and functional mitral regurgitation, levosimendan acutely improved systolic and diastolic function, reduced mitral regurgitation and modulated neurohormonal activation, with a tendency for these changes to persist over a short-term follow-up. © 2010 Italian Federation of Cardiology.