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Kipka H, Liebchen U, Hübner M, Höfner G, Frey O, Wanner KT, Kilger E, Hagl C, Tomasi R, Mannell H. Serum concentrations of levosimendan and its metabolites OR-1855 and OR-1896 in cardiac surgery patients with cardiopulmonary bypass. Front Cardiovasc Med 2024; 11:1406338. [PMID: 39175630 PMCID: PMC11338783 DOI: 10.3389/fcvm.2024.1406338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 04/19/2024] [Indexed: 08/24/2024] Open
Abstract
Background The inotropic drug levosimendan is often used as an individualized therapeutic approach perioperatively in cardiac surgery patients with cardiopulmonary bypass (CPB). Data regarding serum concentrations of levosimendan and its metabolites within this context is lacking. Methods In this retrospective descriptive proof-of-concept study, total serum concentrations (TSC) and unbound fractions (UF) of levosimendan and its metabolites OR-1896 and OR-1855 in cardiac surgery patients with CPB were measured using LC-ESI-MS/MS. Simulation of expected levosimendan TSC was performed using Pharkin 4.0. Serum NT-proBNP was assessed with ELISA. Results After levosimendan infusion (1.25 mg or 2.5 mg, respectively) after anaesthesia induction, a median TSC of 1.9 ng/ml and 10.4 ng/ml was determined in samples taken directly after surgery (T1). Median TSC of 7.6 ng/ml and 22.0 ng/ml, respectively, were simulated at T1. Whereas 1.1 ng/ml and 1.6 ng/ml TSC of OR-1896, respectively, was quantified the day after surgery (T2), TSC of the intermediate metabolite OR-1855 was mostly below the lower limit of quantification (LLOQ). The UF was 0.5% and 1.1% for levosimendan and 64.1% and 52.1% for OR-1896, respectively, with over half the samples being below LLOQ. NT-proBNP concentrations before surgery and T2 did not differ. Discussion The low TSC, UF and unchanged NT-proBNP levels in combination with high variation of serum levels between patients suggest a need for optimized dosing regimen of levosimendan combined with therapeutic drug monitoring for such an individualized approach. In addition, the differences between the measured and estimated concentrations may suggest a possible influence of CPB on levosimendan serum concentrations.
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Affiliation(s)
- Hannah Kipka
- Doctoral Program Clinical Pharmacy, LMU University Hospital, LMU Munich, Germany
- Institute of Cardiovascular Physiology and Pathophysiology, Biomedical Center, LMU Munich, Planegg, Germany
| | - Uwe Liebchen
- Department of Anaesthesiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Max Hübner
- Department of Anaesthesiology, LMU University Hospital, LMU Munich, Munich, Germany
- Walter Brendel Center of Experimental Medicine, LMU Munich, LMU University Hospital, Munich, Germany
| | - Georg Höfner
- Department of Pharmacy, Center for Drug Research, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Otto Frey
- Department of Pharmacy, General Hospital of Heidenheim, Heidenheim, Germany
| | - Klaus T. Wanner
- Department of Pharmacy, Center for Drug Research, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Erich Kilger
- Department of Anaesthesiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, LMU University Hospital, LMU Munich, Germany
- DZHK (German Centre of Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Roland Tomasi
- Department of Anaesthesiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Hanna Mannell
- Doctoral Program Clinical Pharmacy, LMU University Hospital, LMU Munich, Germany
- Institute of Cardiovascular Physiology and Pathophysiology, Biomedical Center, LMU Munich, Planegg, Germany
- Physiology, Institute for Theoretical Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
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Schroeder L, Gries K, Ebach F, Mueller A, Kipfmueller F. Exploratory Assessment of Levosimendan in Infants With Congenital Diaphragmatic Hernia. Pediatr Crit Care Med 2021; 22:e382-e390. [PMID: 33591071 DOI: 10.1097/pcc.0000000000002665] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Infants with congenital diaphragmatic hernia frequently suffer from cardiac dysfunction and pulmonary hypertension during the postnatal course. With the use of the inodilator levosimendan, a therapeutic approach is available in situations with catecholamine-refractory low-cardiac-output failure and severe pulmonary hypertension. DESIGN Retrospective single-center cohort study. SETTING University-based, tertiary-care children's hospital neonatal ICU. PATIENTS Cohort of 24 infants with congenital diaphragmatic hernia and levosimendan therapy, without underlying major cardiac defect, treated at the University Children´s Hospital Bonn, Germany, between January 2017 and December 2018. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Twenty-four infants with congenital diaphragmatic hernia were treated with levosimendan (41% of hospitalized congenital diaphragmatic hernia infants in the study period). In 88%, the congenital diaphragmatic hernia was left-sided. The median observed-to-expected lung-to-head ratio was 36%. About 60% of the infants were supported with venovenous extracorporeal membrane oxygenation and the mortality was 38% (9/24 infants). Levosimendan administration was associated with improvement of pulmonary hypertension severity (p = 0.013 and p = 0.000) and right ventricular dysfunction (p = 0.011 and p = 0.000) at 24 hours and 7 days after treatment. Similarly, the prevalence of left ventricular dysfunction decreased from 50% at baseline to 10% after 7 days (p = 0.026). A significant reduction in the peak inspiratory pressure was observed after drug application (p = 0.038) and a significant decrease of the Vasoactive-Inotropic Score was apparent (p = 0.022). A relevant arterial hypotension as a drug-related adverse event occurred in one patient. CONCLUSIONS This is the first study exploring clinical and hemodynamic changes after levosimendan treatment in a cohort of infants with congenital diaphragmatic hernia. An association of levosimendan application and an improvement in pulmonary hypertension, right ventricular, and left ventricular dysfunction were observed within 7 days after drug infusion. However, due to the retrospective design of this study, the results should be interpreted carefully.
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Affiliation(s)
- Lukas Schroeder
- All authors: Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital Bonn, Bonn, Germany
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Jiang R, Zhao Q, Wu W, Zhang R, Yuan P, Gong S, He J, Luo C, Qiu H, Wang L, Liu J. Efficacy and safety of a calcium sensitizer, levosimendan, in patients with right heart failure due to pulmonary hypertension. CLINICAL RESPIRATORY JOURNAL 2017; 12:1518-1525. [PMID: 28862394 DOI: 10.1111/crj.12699] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 08/18/2017] [Accepted: 08/28/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Rong Jiang
- Department of Cardio‐Pulmonary CirculationShanghai Pulmonary Hospital, Tongji University School of MedicineShanghai200433 China
| | - Qin‐Hua Zhao
- Department of Cardio‐Pulmonary CirculationShanghai Pulmonary Hospital, Tongji University School of MedicineShanghai200433 China
| | - Wen‐Hui Wu
- Department of Cardio‐Pulmonary CirculationShanghai Pulmonary Hospital, Tongji University School of MedicineShanghai200433 China
| | - Rui Zhang
- Department of Cardio‐Pulmonary CirculationShanghai Pulmonary Hospital, Tongji University School of MedicineShanghai200433 China
| | - Ping Yuan
- Department of Cardio‐Pulmonary CirculationShanghai Pulmonary Hospital, Tongji University School of MedicineShanghai200433 China
| | - Su‐Gang Gong
- Department of Cardio‐Pulmonary CirculationShanghai Pulmonary Hospital, Tongji University School of MedicineShanghai200433 China
| | - Jing He
- Department of Cardio‐Pulmonary CirculationShanghai Pulmonary Hospital, Tongji University School of MedicineShanghai200433 China
| | - Ci‐Jun Luo
- Department of Cardio‐Pulmonary CirculationShanghai Pulmonary Hospital, Tongji University School of MedicineShanghai200433 China
| | - Hong‐Ling Qiu
- Department of Cardio‐Pulmonary CirculationShanghai Pulmonary Hospital, Tongji University School of MedicineShanghai200433 China
| | - Lan Wang
- Department of Cardio‐Pulmonary CirculationShanghai Pulmonary Hospital, Tongji University School of MedicineShanghai200433 China
| | - Jin‐Ming Liu
- Department of Cardio‐Pulmonary CirculationShanghai Pulmonary Hospital, Tongji University School of MedicineShanghai200433 China
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Cavusoglu Y, Tek M, Demirustu C. Levosimendan may provide a better neurohormonal response in heart failure patients receiving beta blocker therapy — Reply. Int J Cardiol 2008. [DOI: 10.1016/j.ijcard.2008.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Giamouzis G, Giannakoulas G, Tsarpalis K, Agha SA, Georgiopoulou V, Kalogeropoulos A, Karvounis H, Butler J. Natriuretic peptide-guided levosimendan therapy for heart failure: A promising new approach. Int J Cardiol 2008; 128:91-3; author reply 94-6. [DOI: 10.1016/j.ijcard.2008.01.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2007] [Accepted: 01/11/2008] [Indexed: 10/22/2022]
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