Background: In advanced heart failure (HF), Levosimendan increases peak oxygen uptake (peakVO2). We investigated whether peakVO2 increase is linked to cardiovascular, respiratory or muscular performance changes. Methods and results: Twenty patients hospitalized for advanced HF underwent, before and shortly after Levosimendan infusion, two different cardiopulmonary exercise tests (CPET): a) a personalized ramp protocol with repeated arterial blood gas analysis and standard spirometry including alveolar-capillary gas diffusion measurements at rest and at peak exercise, and b) a step incremental workload CPET with continuous near-infrared spectroscopy analysis and cardiac output (CO) assessment by bioelectrical impedance analysis. Levosimendan significantly reduced natriuretic peptides, improved peakVO2 (11.3 [IQR 10.1-12.8] to 12.6 [10.2-14.4] ml/Kg/min, p<0.01) and reduced VE/VCO2 slope (47.7±10.7 to 43.4±8.1, p<0.01). In parallel, spirometry showed only a minor increase in forced expiratory volume, while peak exercise dead space ventilation was unchanged. However, during exercise, a smaller edema formation was observed after Levosimendan infusion, as inferable from the changes in diffusion components, i.e. membrane diffusion and capillary volume. The end-tidal pressure of CO2 (PetCO2) during the isocapnic buffering period increased after Levosimendan (from 28±3 mmHg to 31±2 mmHg, p<0.01). During exercise, CO increased in parallel with VO2. After Levosimendan, total and oxygenated tissue hemoglobin, but not deoxygenated hemoglobin, increased in all exercise phases. Conclusion: In advanced HF, Levosimendan increases peakVO2, reduces the formation of exercise-induced lung edema, increases ventilation efficiency due to a reduction of reflex hyperventilation, and increases CO and muscular oxygen delivery and extraction.

Why Levosimendan improves the clinical condition of patients with advanced heart failure : a holistic approach / A. Apostolo, C. Vignati, M.D. Della Rocca, F. de Martino, G. Berna, J.S. Campodonico, M. Contini, M. Muratori, P. Palermo, M. Mapelli, M. Alimento, B. Pezzuto, P. Agostoni. - In: JOURNAL OF CARDIAC FAILURE. - ISSN 1071-9164. - 28:3(2022 Mar), pp. 509-514. [10.1016/j.cardfail.2021.10.009]

Why Levosimendan improves the clinical condition of patients with advanced heart failure : a holistic approach

C. Vignati
Secondo
;
M.D. DELLA ROCCA;J.S. Campodonico;M. Mapelli;P. Agostoni
Ultimo
2022-03

Abstract

Background: In advanced heart failure (HF), Levosimendan increases peak oxygen uptake (peakVO2). We investigated whether peakVO2 increase is linked to cardiovascular, respiratory or muscular performance changes. Methods and results: Twenty patients hospitalized for advanced HF underwent, before and shortly after Levosimendan infusion, two different cardiopulmonary exercise tests (CPET): a) a personalized ramp protocol with repeated arterial blood gas analysis and standard spirometry including alveolar-capillary gas diffusion measurements at rest and at peak exercise, and b) a step incremental workload CPET with continuous near-infrared spectroscopy analysis and cardiac output (CO) assessment by bioelectrical impedance analysis. Levosimendan significantly reduced natriuretic peptides, improved peakVO2 (11.3 [IQR 10.1-12.8] to 12.6 [10.2-14.4] ml/Kg/min, p<0.01) and reduced VE/VCO2 slope (47.7±10.7 to 43.4±8.1, p<0.01). In parallel, spirometry showed only a minor increase in forced expiratory volume, while peak exercise dead space ventilation was unchanged. However, during exercise, a smaller edema formation was observed after Levosimendan infusion, as inferable from the changes in diffusion components, i.e. membrane diffusion and capillary volume. The end-tidal pressure of CO2 (PetCO2) during the isocapnic buffering period increased after Levosimendan (from 28±3 mmHg to 31±2 mmHg, p<0.01). During exercise, CO increased in parallel with VO2. After Levosimendan, total and oxygenated tissue hemoglobin, but not deoxygenated hemoglobin, increased in all exercise phases. Conclusion: In advanced HF, Levosimendan increases peakVO2, reduces the formation of exercise-induced lung edema, increases ventilation efficiency due to a reduction of reflex hyperventilation, and increases CO and muscular oxygen delivery and extraction.
Levosimendan; heart failure; cardiopulmonary exercise test
Settore MED/11 - Malattie dell'Apparato Cardiovascolare
8-nov-2021
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/882817
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