Introduction
Methods
Study design and patient population
Data collection
Patients’ management
Study endpoints
Statistical analysis
Results
Population
Baseline characteristics and outcomes in the unmatched cohort
All (n = 200) | Levosimendan (n = 53) | Control (n = 147) | p value | |
---|---|---|---|---|
Clinical characteristics at ICU admission | ||||
Age (years) | 53 ± 13.5 | 53.9 ± 14.3 | 52.6 ± 13.3 | 0.575 |
Male | 129 (64.5) | 33 (62.3) | 96 (65.3) | 0.692 |
BMI (kg/m2) | 25.3 ± 5.4 | 25.3 ± 5.6 | 25.3 ± 5.3 | 0.975 |
SAPS-II | 52.2 ± 14.3 | 53.5 ± 10.8 | 51.7 ± 15.4 | 0.349 |
SOFA | 11.7 ± 2.1 | 11.5 ± 1.5 | 11.8 ± 2.2 | 0.459 |
Comorbidities | ||||
Hypertension | 62 (31) | 18 (34) | 44 (29.9) | 0.587 |
Diabetes | 36 (18) | 11 (20.8) | 25 (17) | 0.430 |
History of congestive heart failure | 101 (51) | 26 (50) | 75 (51.4) | 0.865 |
Coronary artery disease | 88 (44) | 27 (50.9) | 61 (41.5) | 0.235 |
Peripheral artery disease | 11 (5.5) | 4 (7.5) | 7 (4.8) | 0.446 |
History of stroke | 14 (7) | 5 (9.4) | 9 (6.1) | 0.418 |
Smoking | 71 (35.5) | 18 (34) | 53 (36.1) | 0.785 |
Dyslipidemia | 49 (24.5) | 14 (26.4) | 35 (23.8) | 0.705 |
Renal failure with dialysis | 15 (7.5) | 3 (5.6) | 12 (8.1) | 0.553 |
Indication for VA-ECMO | 0.068 | |||
Post-cardiotomy | 59 (29.5) | 18 (34) | 41 (27.9) | |
Acute myocardial infarction | 45 (22.5) | 17 (32.1) | 28 (19) | |
Graft dysfunction | 33 (16.5) | 3 (5.7) | 30 (20.4) | |
Dilated cardiomyopathy | 15 (7.5) | 5 (9.4) | 10 (6.8) | |
Intoxication | 14 (7) | 0 (0) | 14 (9) | |
Fulminant myocarditis | 13 (6.5) | 3 (5.7) | 10 (6.8) | |
Pulmonary embolism | 6 (3) | 2 (3.8) | 4 (2.7) | |
Septic cardiomyopathy | 6 (3) | 2 (3.8) | 4 (2.7) | |
Others | 9 (4.5) | 3 (5.6) | 6 (4) | |
Potential for myocardial recovery | 0.264 | |||
High | 39 (19.5) | 7 (13.2) | 32 (21.8) | |
Intermediate | 86 (43) | 22 (41.5) | 64 (43.5) | |
Low | 75 (37.5) | 24 (45.3) | 51 (34.7) | |
Hemodynamic parameters at admission | ||||
LVEF (%) | 19.6 ± 11.3 | 18 ± 11.1 | 20.2 ± 11.4 | 0.241 |
TAPSE < 12 (mm) | 45 (30.8) | 15 (34.8) | 30 (29.1) | 0.489 |
MAP (mmHg) | 69 ± 11 | 70 ± 11 | 69 ± 11 | 0.643 |
HR (beats/min) | 103 ± 24 | 108 ± 21 | 102 ± 25 | 0.145 |
CVP (mmHg) | 10.6 ± 5 | 10.8 ± 5.5 | 10.6 ± 4.9 | 0.798 |
ScvO2 (%) | 62 ± 11 | 60 ± 12 | 63 ± 11 | 0.065 |
VA-ECMO characteristics | ||||
VA-ECMO duration (days) | 7.6 ± 5 | 10.6 ± 4.8 | 6.5 ± 4.7 | < 0.001 |
Flow rate (L/min) | 3.5 ± 0.8 | 3.4 ± 0.8 | 3.5 ± 0.8 | 0.835 |
Rotation (round/min) | 4360 ± 1711 | 4480 ± 1724 | 4312 ± 1710 | 0.547 |
FiO2 (%) | 59 ± 12 | 58 ± 12 | 59 ± 13 | 0.977 |
Peripheral VA-ECMO canulation | 175 (87.5) | 48 (90.6) | 127 (86.4) | 0.496 |
IABP associated to VA-ECMO | 54 (27) | 16 (30.1) | 38 (25.8) | 0.542 |
Biological parameters | ||||
Hemoglobin level (g/dL) | 113 ± 25 | 114 ± 26 | 113 ± 24 | 0.717 |
International normalized ratio | 1.6 ± 0.6 | 1.5 ± 0.5 | 1.6 ± 0.6 | 0.338 |
Arterial blood pH | 7.26 ± ± 0.1 | 7.27 ± 0.1 | 7.26 ± 0.1 | 0.652 |
Lactate level (mmol/L) | 7.2 ± 5.1 | 6.4 ± 4.7 | 7.5 ± 5.3 | 0.178 |
Creatinine level (μmol/L) | 152 ± 78 | 150 ± 77 | 153 ± 79 | 0.843 |
Total bilirubin level (μmol/L) | 23 ± 17 | 22 ± 17 | 24 ± 17 | 0.457 |
ASAT (U/L) | 763 ± 1819 | 717 ± ± 1454 | 781 ± 1945 | 0.828 |
ALAT (U/L) | 390 ± 907 | 295 ± 610 | 426 ± 998 | 0.372 |
Catecholamines during ICU stay | ||||
Norepinephrine max dose (μg/kg/min) | 1.49 ± 1.05 | 1.56 ± 1.07 | 1.47 ± 1.04 | 0.586 |
Norepinephrine duration (days) | 10.9 ± 8.7 | 12.8 ± 7.2 | 10.2 ± 9.2 | 0.068 |
Dobutamine max dose (μg/kg/min) | 9.7 ± 4.6 | 10.4 ± 10.2 | 9.5 ± 4.3 | 0.309 |
Dobutamine duration (days) | 9.1 ± 7.9 | 10.3 ± 10.2 | 8.6 ± 6.6 | 0.203 |
Baseline characteristics and outcomes after propensity score analysis
Unmatched* | Matched | |||||
---|---|---|---|---|---|---|
Levosimendan (n = 48) | Control (n = 128) | p | Levosimendan (n = 48) | Control (n = 78) | p | |
Variable (mean) | ||||||
Age (years) | 53.9 | 52.6 | 0.575 | 54.3 | 54.7 | 0.866 |
Male (%) | 62 | 65 | 0.692 | 0.62 | 0.65 | 0.785 |
Potential for recovery | 2.32 | 2.12 | 0.104 | 2.31 | 2.35 | 0.747 |
SAPS-II | 53.5 | 51.7 | 0.424 | 52.7 | 52.1 | 0.824 |
SOFA | 11.5 | 11.8 | 0.530 | 11.3 | 11.5 | 0.687 |
LVEF (%) | 18 | 20.2 | 0.241 | 18 | 17 | 0.690 |
VA-ECMO duration (days) | 10.6 | 6.5 | <0.001 | 10.8 | 10.2 | 0.478 |
Serum lactate level (mmol/L) | 6.4 | 7.5 | 0.178 | 6.3 | 6.1 | 0.816 |