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Open AccessArticle

Levosimendan Improves Oxidative Balance in Cardiogenic Shock/Low Cardiac Output Patients

Laboratory of Physiology, Department of Translational Medicine, UPO, 28100 Novara, Italy
Cardiothoracic Intensive Care Unit, AOU, 28100 Novara, Italy
Cardiology Division, AOU, 28100 Novara, Italy
Critical Care, OrionPharma, 02101 Espoo, Finland
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(2), 373;
Received: 18 December 2019 / Revised: 22 January 2020 / Accepted: 25 January 2020 / Published: 30 January 2020
The beneficial effects exerted by levosimendan against cardiac failure could be related to the modulation of oxidative balance. We aimed to examine the effects of levosimendan in patients with cardiogenic shock or low cardiac output on cardiac systo-diastolic function and plasma oxidants/antioxidants (glutathione, GSH; thiobarbituric acid reactive substances, TBARS). In four patients undergoing coronary artery bypass grafting or angioplasty, cardiovascular parameters and plasma GSH and TBARS were measured at T0 (before levosimendan infusion), T1 (1 h after the achievement of the therapeutic dosage of levosimendan), T2 (end of levosimendan infusion), T3 (72 h after the end of levosimendan infusion), and T4 (end of cardiogenic shock). We found an improvement in the indices of systolic (ejection fraction, cardiac output, cardiac index) and diastolic (E to early diastolic mitral annular tissue velocity, E/’; early to late diastolic transmitral flow velocity, EA) cardiac function at early T2. A reduction of central venous pressure and pulmonary wedge pressure was also observed. Plasma levels of GSH and TBARS were restored by levosimendan at T1, as well. The results obtained indicate that levosimendan administration can regulate oxidant/antioxidant balance as an early effect in cardiogenic shock/low cardiac output patients. Modulation of oxidative status on a mitochondrial level could thus play a role in exerting the cardio-protection exerted by levosimendan in these patients. View Full-Text
Keywords: antioxidants; calcium sensitizer; heart failure; mitochondria function; peroxidation antioxidants; calcium sensitizer; heart failure; mitochondria function; peroxidation
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Grossini, E.; Farruggio, S.; Pierelli, D.; Bolzani, V.; Rossi, L.; Pollesello, P.; Monaco, C. Levosimendan Improves Oxidative Balance in Cardiogenic Shock/Low Cardiac Output Patients. J. Clin. Med. 2020, 9, 373.

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