Outcomes of the patients of heart failure with reduced ejection fraction receiving inotropic support in initial 6 hours: Insights from Manipal Heart Failure Registry

Heart failure (HF) is responsible for 1.8 million admissions annually in India with an additional burden of mortalityand re-hospitalizations. Positive inotropes with multiple mechanisms, such as dopamine and levosimendan, are beingused for more than three decades to treat the patients of acute HF with reduced ejection fraction (HFrEF). This studycompared the outcomes of the dopamine and the levosimendan up to 180 days. We have selected the patients fromManipal Heart Failure Registry who were diagnosed to have HFrEF (left ventricular EF less than 50%) and wereinitiated on either dopamine or levosimendan in first 6 hours of hospitalization. The study included a total of 187patients; among them, 120 patients were analyzed in the dopamine group, and 67 patients in the levosimendan group.Dopamine was initiated as intravenous infusion with the dose of 2.5 microgram/kilogram/minute (mcg/kg/minute)and up-titrated up to 10 mcg/kg/minute. Levosimendan was also administered intravenously with a dose of 0.1 mcg/kg/minute and up-titrated up to 0.4 mcg/kg/minute. The primary outcomes include a composite of all-cause mortalityand re-hospitalization at 30-days and 180-days follow-ups. The in-hospital mortality, 30-days mortality and 180-daysmortality, and composite outcomes were noted higher in levosimendan treated patients even after matched demographicparameters (age and gender) and comparable comorbidities and risk factors, i.e., smoking, alcohol consumption,hypertension, diabetes mellitus, and atrial fibrillation. However, reduced EF, raised serum creatinine, procalcitonin,and N-terminal pro b-type natriuretic peptide levels and high use of digoxin were noticed in levosimendan groupduring the initial period of index-hospitalization and these can be considered as confounding factors for future studies.

Cardiac Dysfunction in Patients with Sepsis, Severe Sepsis and Septic Shock.

Aims: Patients with severe sepsis and septic shock often exhibit significant cardiovascular dysfunction. We designed the study with an aim to determine the severity of cardiac dysfunction in the different group of sepsis patients. Study Design: Single-center, cross-sectional study Place and Duration of Study: The study was carried out at Department of Cardiology, Kasturba Medical College and Hospital, Manipal from June 2011 to December 2012. Methodology: A total of 74 patients who were diagnosed with sepsis were enrolled in the study. All patients were subjected to routine analysis, laboratory test and echocardiogrphic assessment. Results: The patients were divided into 3 groups: sepsis group (n = 11), severe sepsis group (n =37) and septic shock group (n = 26). The mitral E/A value is significantly higher in patients with septic shock than that of the patients with sepsis (P = 0.04). The indices of right ventricular dysfunction did not show any significant difference in the patients with septic shock and that of sepsis. Conclusion: Left ventricular dysfunction may be considered prevalent in sepsis as per the significant E/A values. However, the other echocardiographic parameter should also be considered. This may even infer that cardiac dysfunction may not correlate with the severity of sepsis.