Levosimendan reduces symptoms and improves hemodynamics in patients with acutely decompensated
chronic heart failure (ADCHF). The aim of this study was to investigate (1) the association
of changes induced by low-dose dobutamine stress echocardiography in 2-dimensional
strain parameters with the corresponding changes in the left ventricular (LV) ejection
fraction (EF) and LV outflow tract velocity time integral (VTI) in patients with ADCHF
and (2) whether LV contractile reserve assessed by conventional and speckle-tracking
echocardiography is associated with clinical and neurohumoral improvement after levosimendan
treatment. Twenty-eight consecutive patients with ADCHF (mean age 65 ± 10 years, mean
New York Heart Association class 3.6 ± 0.3, mean EF 22 ± 6%) were studied using dobutamine
stress echocardiography before 24-hour infusion of levosimendan. The LV EF, VTI, and
mean longitudinal, circumferential, and radial strain and strain rate using speckle-tracking
imaging were measured. Twenty-one patients (75%) had evidence of contractile reserve
(LV EF increase >10% and VTI increase >20% after peak dobutamine dose). Patients with
versus without contractile reserve demonstrated greater improvements in New York Heart
Association class (mean change −1.0 ± 0.5 vs −0.5 ± 0.3, p = 0.01) and reductions
in B-type natriuretic peptide levels (−34 ± 30% vs +4 ± 31%, p <0.01) 48 hours after
treatment. On multivariate analysis, mean longitudinal systolic strain rate reserve
(peak longitudinal strain rate minus longitudinal strain rate at rest) was the best
predictor of improvement in New York Heart Association class (p = 0.039) and B-type
natriuretic peptide level (p = 0.042) after levosimendan among the reserve of LV fractional
shortening, the EF, VTI, and longitudinal, circumferential, and radial strain and
strain rate. In conclusion, dobutamine-induced changes in longitudinal systolic strain
rate are associated with clinical and neurohumoral improvement after levosimendan
treatment in patients with ADCHF.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Safety and efficacy of a novel calcium sensitizer, levosimendan, in patients with left ventricular failure due to an acute myocardial infarction.Eur Heart J. 2002; 23: 1422-1432
- Efficacy and safety of intravenous levosimendan compared with dobutamine in severe low-output heart failure (the LIDO study): a randomized double-blind trial.Lancet. 2002; 360: 196-202
- Levosimendan vs dobutamine for patients with acute decompensated heart failure: the SURVIVE randomized trial.JAMA. 2007; 297: 1883-1891
- Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: the Task Force on Acute Heart Failure of the European Society of Cardiology.Eur Heart J. 2005; 26: 384-416
- Acute hemodynamic and clinical effects of levosimendan in patients with severe heart failure.Circulation. 2000; 102: 2222-2227
- Dobutamine echocardiographic study in patients with nonischemic dilated cardiomyopathy and prognostically borderline values of peak exercise oxygen consumption: 18-month follow-up study.J Am Coll Cardiol. 2001; 37: 1685-1691
- ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography—summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography).J Am Coll Cardiol. 2003; 42: 954-970
- Relation between contractile reserve and improvement in left ventricular function with beta-blocker therapy in patients with heart failure secondary to ischemic or idiopathic dilated cardiomyopathy.Am J Cardiol. 2004; 93: 854-859
- Non-Doppler two-dimensional strain imaging by echocardiography—from technical considerations to clinical applications.J Am Soc Echocardiogr. 2007; 20: 234-243
- Influence of preoperative left ventricular contractile reserve on postoperative ejection fraction in low-gradient aortic stenosis.Circulation. 2006; 113: 1738-1744
- Incremental value of strain rate analysis as an adjunct to wall-motion scoring for assessment of myocardial viability by dobutamine echocardiography: a follow-up study after revascularization.Circulation. 2005; 112: 3892-3900
- Strain rate analysis allows detection of differences in diastolic function between viable and nonviable myocardial segments.J Am Soc Echocardiogr. 2005; 18: 330-335
- Two-dimensional strain-a novel software for real-time quantitative echocardiographic assessment of myocardial function.J Am Soc Echocardiogr. 2004; 17: 1021-1029
- Global and regional myocardial function quantification by two-dimensional strain: application in hypertrophic cardiomyopathy.J Am Coll Cardiol. 2006; 47: 1175-1181
- Left ventricular form and function revisited: applied translational science to cardiovascular ultrasound imaging.J Am Soc Echocardiogr. 2007; 20: 539-551
- Head-to-head comparison of indices of left ventricular contractile reserve assessed by high-dose dobutamine stress echocardiography in idiopathic dilated cardiomyopathy: five-year follow up.Heart. 2006; 92: 1253-1258
Article info
Publication history
Published online: September 09, 2008
Accepted:
June 30,
2008
Received in revised form:
June 30,
2008
Received:
May 27,
2008
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
