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Levosimendan bei der Therapie der akuten hamodynamisch bedeutsamen Lungenembolie


, : Levosimendan bei der Therapie der akuten hamodynamisch bedeutsamen Lungenembolie. Intensivmedizin und Notfallmedizin 43(8): 636-642

Background Right ventricular competence plays a pivotal role in the clinical course of acute pulmonary embolism. A fatal outcome of an event is mainly due to right heart failure. Levosimendan is a calcium sensitizer, which so far has been evaluated in the setting of left heart failure. We describe the effects of levosimendan in the setting of right heart failure due to acute pulmonary embolism. Methods and results We evaluated the hemodynamic effects and the clinical course of 7 patients in whom therapy of acute pulmonary embolism was augmented by levosimendan. All patients showed echocardiographic signs of right ventricular distension; 6 of the 7 patients showed hypotension with a systemic systolic blood pressure of < 90 mmHg. Under therapy with levosimendan 6 of the 7 cases showed a rapid clinical and hemodynamic recovery, characterized by a significant decrease of systolic pulmonary artery pressure and heart rate within the next 12 and 24 hours. Six patients survived the event. Therapy with levosimendan was not discontinued in any patient. Four patients were treated in addition with fibrinolysis, while 3 patients were treated with heparin alone. In none of these patients was an escalation in therapy required. Conclusion This is a first report of a successful use of levosimendan in the setting of acute right heart failure due to acute pulmonary embolism. Randomized prospective trials are necessary to validate these acute results, to check for side effects and prognostic implications in a larger number of patients, before this kind of therapy can be recommended for regular therapy.

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