Inotropic and lusitropic effects of levosimendan and milrinone assessed by strain echocardiography: A randomised trial

• BackgroundWe compared the direct inotropic and lusitropic effects of two inodilators, milrinone and levosimendan in patients after aortic valve replacement for aortic stenosis. MethodsIn this randomised, blinded study, 31 patients with normal LV function, were randomised to either levosimendan (0.1 and 0.2g/kg/min, n=15) or milrinone (0.4 and 0.8g/kg/min, n=16) after aortic valve replacement. The effects on LV performance, LV strain, systolic (SR-S) and early diastolic (SR-E) strain rate were assessed by a pulmonary artery catheter and transoesophageal two-dimensional speckle tracking echocardiography of the LV inferior wall. To circumvent the inodilator-induced hemodynamic changes on LV systolic and diastolic deformation, central venous pressure (CVP), systolic artery pressure (SAP), and heart rate were maintained constant by colloid infusion, phenylephrine-induced vasoconstriction and atrial pacing, respectively, during drug infusion. ResultsBoth inotropic agents induced a dose-dependent increase in cardiac index and stroke volume index by approximately 20% at the highest infusion rates with no differences between groups (P=.139 and .249, respectively). CVP, pulmonary capillary wedge pressure, SAP and heart rate were maintained constant in both groups. LV strain and SR-S increased with both agents, dose-dependently, by 17%-18% and 25%-30%, respectively, at the highest infusion rates, with no difference between groups (P=.434 and .284, respectively). Both agents improved early LV relaxation with no differences between groups (P=.637). At the higher doses, both agents increased SR-E by 30%. ConclusionsAt clinically relevant infusion rates and a certain increase in LV performance the direct inotropic and lusitropic of milrinone and levosimendan were comparable.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)

Nyckelord

cardiac surgery

diastole

left ventricular function

levosimendan

milrinone

strain echocardiography

left-ventricular relaxation

aortic-valve-replacement

failing human

myocardium

diastolic function

heart-failure

doppler

performance

phosphodiesterase-3

angioplasty

inhibition

Anesthesiology

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