Use of Levosimendan in patients with noncoronary dilated cardiomyopathy before organ-preserving reconstructive surgery of reverse heart remodeling

• Maksim A. Babaev
• Aleksandr A. Eremenko
• Zyulyaeva T.P.
• Svetlana V. Fedulova
• E.Yu. Van
• Rizun L.I.
• T.S. Voronina
• Frolova Yu.V.
• D.V. Buchaenko
• Polyakova P.V.

Abstract

Aims – to identify possibilities of preoperative diagnostics of myocardial reserves with the use of levosimendan infusion on the basis of changes in the functional performance of the left ventricular and the degree of valvular insufficiency in patients with noncoronary cardiomyopathy of different etiologies.

Indications of use of levosimendan in 13 patients were: ejection fraction less <30%, stroke volume <80 ml, expressed tricuspid insufficiency (IV degree of severity – 5/38,5%, III degree of severity – 8/61,5%), mitral insufficiency (IV degree of severity – 6/46,2%, III degree of severity – 7/53,8%), lung hypertension (II degree of severity – 9/69,2%, III degree of severity – 5/30,8%) due to high values of pulmonary artery pressure – 52±3 (mm/hg), end-diastolic volume (274±28 ml) and end-systolic volume (198±26 ml), Euroscore – 6,5±0,6. The dose of levosimendan was 0,025 up to 0,1 mgk/kg/min. All patients underwent organpreserving surgery of reverse heart remodeling. Expressed benefit of levosimendan infusion was registered in majority of patients (85,7%) with viral myocarditis in medical history (55,6%), Euroscore 5,5–6,5: in 69,2% was registered decreasing of severity grade of mitral insuf- ficiency, tricuspid insufficiency and lung hypertension. In the group where significant effects of the levosimendan infusion were not registered the autoimmune process was the main cause of dilated cardiomyopathy and scores according to Euroscore were >7.

Preventive use of levosimendan allows to evaluate myocardial reserves and prepare high risk patients with noncoronary dilated cardiomyopathy, without multi-organ dysfunction, for the organ-preserving surgery. Efficiency of the drug directly depends on the etiology of dilated cardiomyopathy and severity of heart failure.

Keywords:levosimendan, heart failure, dilated cardiomyopathy, myocardial reserves, reverse heart remodeling, Euroscore scale

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