Original Paper

Clinical Research in Cardiology

, Volume 100, Issue 7, pp 571-577

Effect of levosimendan and predictors of recovery in patients with peripartum cardiomyopathy, a randomized clinical trial

  • Murat BitekerAffiliated withDepartment of Cardiology, Haydarpaşa Numune Education and Research Hospital Email author 
  • , Nilüfer Ekşi DuranAffiliated withDepartment of Cardiology, Kosuyolu Kartal Heart Education and Research Hospital
  • , Hasan KayaAffiliated withDepartment of Cardiology, Kosuyolu Kartal Heart Education and Research Hospital
  • , Sabahattin GündüzAffiliated withDepartment of Cardiology, Kosuyolu Kartal Heart Education and Research Hospital
  • , Halil İbrahim TanboğaAffiliated withDepartment of Cardiology, Kosuyolu Kartal Heart Education and Research Hospital
  • , Tayyar GökdenizAffiliated withDepartment of Cardiology, Kosuyolu Kartal Heart Education and Research Hospital
  • , Gökhan KahveciAffiliated withDepartment of Cardiology, Kosuyolu Kartal Heart Education and Research Hospital
  • , Taylan AkgünAffiliated withDepartment of Cardiology, Kosuyolu Kartal Heart Education and Research Hospital
  • , Mustafa YıldızAffiliated withDepartment of Cardiology, Kosuyolu Kartal Heart Education and Research Hospital
    • , Mehmet ÖzkanAffiliated withDepartment of Cardiology, Kosuyolu Kartal Heart Education and Research Hospital

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Abstract

Background

Levosimendan is a promising new inodilator agent but its effectiveness in peripartum cardiomyopathy (PPCM) has not been tested in a clinical trial. The authors sought to evaluate the effect of levosimendan therapy and to determine the predictors of clinical outcome in patients with PPCM.

Methods and results

The authors prospectively randomized 24 consecutive women with PPCM. Twelve patients (control group) were randomized to conventional heart failure therapy and 12 patients (levosimendan group) were randomized to levosimendan in addition to the conventional therapy. Mean follow-up period was 20.9 ± 9 months (ranged 12–38 months). The two groups did not differ in baseline demographic and echocardiographic characteristics. Eleven patients (45.8%) recovered completely (6 in control group and 5 in levosimendan group, p > 0.05), 6 died (25%) (3 in control group and 3 in levosimendan group), and 7 (29.1%) were left with persistent left ventricular dysfunction (PLVD) (3 in control group and 4 in levosimendan group, p > 0.05). There were significant differences in baseline characteristics between deceased patients and survivors including left ventricular end-diastolic diameter (7.1 ± 0.6 vs. 6.4 ± 0.5 cm, p = 0.031), left ventricular end-systolic diameter (LVESD) (6.4 ± 0.8 vs. 5.5 ± 0.6 cm, p = 0.027), left ventricular ejection fraction (LVEF) (19.7 vs. 27.4%, p = 0.025), and left atrial diameter (4.9 ± 0.3 vs. 4.3 ± 0.4 cm, p = 0.011).

Conclusions

Addition of levosimendan to conventional therapy did not improve outcome in patients with PPCM. In patients with PLVD or patients who died, LVEF, LVESD and left atrial diameter were worse than those with complete resolution.

Keywords

Levosimendan Peripartum cardiomyopathy Treatment