Safety and feasibility of levosimendan administration in takotsubo cardiomyopathy: A case series

Francesco Santoro, Riccardo Ieva, Armando Ferraretti, Vincenzo Ienco, Giuseppe Carpagnano, Michele Lodispoto, Luigi Di Biase, Matteo Di Biase, Natale Daniele Brunetti

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Background: Levosimendan is a noncatecholamine inotrope that does not increase oxygen consumption, utilized for the treatment for acute heart failure with left ventricular (LV) systolic dysfunction. Its use in takotsubo cardiomyopathy (TTC), a disease that contraindicates the use of catecholamine inotropes, is not well known. Methods: We prospectively analyzed 13 consecutive patients with TTC, low ejection fraction (EF) (<35%), and additional Mayo Clinic risk factors who were treated with i.v. infusion of levosimendan. Clinical course of patients, electrocardiogram presentation, LV function, and adverse events at follow-up were recorded. Results: All patients showed an impaired LV function (LVEF at admission 28 ± 5%), which significantly improved at discharge (51 ± 8%, P < 0.001). Mean hospital stay was 10 ± 4 days. Troponin levels at admission were directly related to length of hospitalization (r = 0.6, P < 0.001). Male gender (relative risk (RR) 1.85, P < 0.05), physical stress (RR 1.90, P < 0.05), ST elevation at ECG (RR 1.87, P < 0.05), and absence of chest pain (RR 2.23, P < 0.01) were found to be the predictors of longer hospital stay. Only 15% of subjects had adverse events during hospital stay; two patients incurred noncardiovascular death at follow-up. Age was the only predictor of adverse event at follow-up (RR 2.13, P < 0.05). Conclusions: The use of levosimendan may be safe and feasible in patients with TTC. Randomized studies are warranted to further confirm these preliminary results.

Original languageEnglish (US)
JournalCardiovascular Therapeutics
Volume31
Issue number6
DOIs
StatePublished - Dec 2013
Externally publishedYes

Fingerprint

Takotsubo Cardiomyopathy
Safety
Length of Stay
Left Ventricular Function
Electrocardiography
Troponin
Left Ventricular Dysfunction
Chest Pain
Oxygen Consumption
Catecholamines
Hospitalization
Heart Failure
simendan

Keywords

  • Heart failure
  • Levosimendan
  • Safety
  • Takotsubo cardiomyopathy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)
  • Pharmacology

Cite this

Santoro, F., Ieva, R., Ferraretti, A., Ienco, V., Carpagnano, G., Lodispoto, M., ... Brunetti, N. D. (2013). Safety and feasibility of levosimendan administration in takotsubo cardiomyopathy: A case series. Cardiovascular Therapeutics, 31(6). https://doi.org/10.1111/1755-5922.12047

Safety and feasibility of levosimendan administration in takotsubo cardiomyopathy : A case series. / Santoro, Francesco; Ieva, Riccardo; Ferraretti, Armando; Ienco, Vincenzo; Carpagnano, Giuseppe; Lodispoto, Michele; Di Biase, Luigi; Di Biase, Matteo; Brunetti, Natale Daniele.

In: Cardiovascular Therapeutics, Vol. 31, No. 6, 12.2013.

Research output: Contribution to journalArticle

Santoro, F, Ieva, R, Ferraretti, A, Ienco, V, Carpagnano, G, Lodispoto, M, Di Biase, L, Di Biase, M & Brunetti, ND 2013, 'Safety and feasibility of levosimendan administration in takotsubo cardiomyopathy: A case series', Cardiovascular Therapeutics, vol. 31, no. 6. https://doi.org/10.1111/1755-5922.12047
Santoro, Francesco ; Ieva, Riccardo ; Ferraretti, Armando ; Ienco, Vincenzo ; Carpagnano, Giuseppe ; Lodispoto, Michele ; Di Biase, Luigi ; Di Biase, Matteo ; Brunetti, Natale Daniele. / Safety and feasibility of levosimendan administration in takotsubo cardiomyopathy : A case series. In: Cardiovascular Therapeutics. 2013 ; Vol. 31, No. 6.
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title = "Safety and feasibility of levosimendan administration in takotsubo cardiomyopathy: A case series",
abstract = "Background: Levosimendan is a noncatecholamine inotrope that does not increase oxygen consumption, utilized for the treatment for acute heart failure with left ventricular (LV) systolic dysfunction. Its use in takotsubo cardiomyopathy (TTC), a disease that contraindicates the use of catecholamine inotropes, is not well known. Methods: We prospectively analyzed 13 consecutive patients with TTC, low ejection fraction (EF) (<35{\%}), and additional Mayo Clinic risk factors who were treated with i.v. infusion of levosimendan. Clinical course of patients, electrocardiogram presentation, LV function, and adverse events at follow-up were recorded. Results: All patients showed an impaired LV function (LVEF at admission 28 ± 5{\%}), which significantly improved at discharge (51 ± 8{\%}, P < 0.001). Mean hospital stay was 10 ± 4 days. Troponin levels at admission were directly related to length of hospitalization (r = 0.6, P < 0.001). Male gender (relative risk (RR) 1.85, P < 0.05), physical stress (RR 1.90, P < 0.05), ST elevation at ECG (RR 1.87, P < 0.05), and absence of chest pain (RR 2.23, P < 0.01) were found to be the predictors of longer hospital stay. Only 15{\%} of subjects had adverse events during hospital stay; two patients incurred noncardiovascular death at follow-up. Age was the only predictor of adverse event at follow-up (RR 2.13, P < 0.05). Conclusions: The use of levosimendan may be safe and feasible in patients with TTC. Randomized studies are warranted to further confirm these preliminary results.",
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T1 - Safety and feasibility of levosimendan administration in takotsubo cardiomyopathy

T2 - A case series

AU - Santoro, Francesco

AU - Ieva, Riccardo

AU - Ferraretti, Armando

AU - Ienco, Vincenzo

AU - Carpagnano, Giuseppe

AU - Lodispoto, Michele

AU - Di Biase, Luigi

AU - Di Biase, Matteo

AU - Brunetti, Natale Daniele

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N2 - Background: Levosimendan is a noncatecholamine inotrope that does not increase oxygen consumption, utilized for the treatment for acute heart failure with left ventricular (LV) systolic dysfunction. Its use in takotsubo cardiomyopathy (TTC), a disease that contraindicates the use of catecholamine inotropes, is not well known. Methods: We prospectively analyzed 13 consecutive patients with TTC, low ejection fraction (EF) (<35%), and additional Mayo Clinic risk factors who were treated with i.v. infusion of levosimendan. Clinical course of patients, electrocardiogram presentation, LV function, and adverse events at follow-up were recorded. Results: All patients showed an impaired LV function (LVEF at admission 28 ± 5%), which significantly improved at discharge (51 ± 8%, P < 0.001). Mean hospital stay was 10 ± 4 days. Troponin levels at admission were directly related to length of hospitalization (r = 0.6, P < 0.001). Male gender (relative risk (RR) 1.85, P < 0.05), physical stress (RR 1.90, P < 0.05), ST elevation at ECG (RR 1.87, P < 0.05), and absence of chest pain (RR 2.23, P < 0.01) were found to be the predictors of longer hospital stay. Only 15% of subjects had adverse events during hospital stay; two patients incurred noncardiovascular death at follow-up. Age was the only predictor of adverse event at follow-up (RR 2.13, P < 0.05). Conclusions: The use of levosimendan may be safe and feasible in patients with TTC. Randomized studies are warranted to further confirm these preliminary results.

AB - Background: Levosimendan is a noncatecholamine inotrope that does not increase oxygen consumption, utilized for the treatment for acute heart failure with left ventricular (LV) systolic dysfunction. Its use in takotsubo cardiomyopathy (TTC), a disease that contraindicates the use of catecholamine inotropes, is not well known. Methods: We prospectively analyzed 13 consecutive patients with TTC, low ejection fraction (EF) (<35%), and additional Mayo Clinic risk factors who were treated with i.v. infusion of levosimendan. Clinical course of patients, electrocardiogram presentation, LV function, and adverse events at follow-up were recorded. Results: All patients showed an impaired LV function (LVEF at admission 28 ± 5%), which significantly improved at discharge (51 ± 8%, P < 0.001). Mean hospital stay was 10 ± 4 days. Troponin levels at admission were directly related to length of hospitalization (r = 0.6, P < 0.001). Male gender (relative risk (RR) 1.85, P < 0.05), physical stress (RR 1.90, P < 0.05), ST elevation at ECG (RR 1.87, P < 0.05), and absence of chest pain (RR 2.23, P < 0.01) were found to be the predictors of longer hospital stay. Only 15% of subjects had adverse events during hospital stay; two patients incurred noncardiovascular death at follow-up. Age was the only predictor of adverse event at follow-up (RR 2.13, P < 0.05). Conclusions: The use of levosimendan may be safe and feasible in patients with TTC. Randomized studies are warranted to further confirm these preliminary results.

KW - Heart failure

KW - Levosimendan

KW - Safety

KW - Takotsubo cardiomyopathy

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