Effective use of levosimendan in anthracycline-induced cardiomyopathy: A case report.

BACKGROUND: Anthracycline-induced cardiomyopathy is a serious side effect that ranges from mild left ventricular systolic impairment to congestive heart failure and cardiogenic shock. Currently, there is no evidence indicating the effective use of levosimendan in these cases. OBJECTIVE: We aim to present a case of life-threatening doxorubicin-induced cardiomyopathy that was successfully managed with levosimendan. CASE: A 48-year-old female with formerly normal heart function, who had been treated with doxorubicin-based regimens for dedifferentiated chondrosarcoma, presented with cardiomyopathy with low left ventricular ejection fraction eight months after the last infusion. As treatment with ramipril, carvedilol, and furosemide followed by dopamine and noradrenaline was not sufficient, levosimendan was administered. Left ventricular ejection fraction increased from 15% to 45% and her clinical condition improved. DISCUSSION: Although anthracycline-induced cardiomyopathy may have a poor prognosis, levosimendan was shown to be effective in this patient. Therefore, levosimendan may represent a possible therapeutic option in such cases.

The role of sex and biochemical markers of inflammation in left ventricular remodelling, before and after surgery, in elderly patients with aortic valve stenosis.

INTRODUCTION: The aim of this study was to determine whether sex and biochemical markers of inflammation have a role in left ventricular (LV) remodelling after aortic valve replacement in elderly patients with aortic valve stenosis. METHODS: We studied 52 elderly patients with aortic valve stenosis (32 men, mean age 65 +/- 11 years and 20 women, mean age 68 +/- 9 years). Body surface area did not differ between men and women (1.81 +/- 0.15 versus 1.84 +/- 0.20, respectively). All patients underwent a complete echocardiographic examination for the determination of ejection fraction (EF), LV mass and mass index, peak and mean systolic pressure gradient, aortic valve area, early (E) and late (A) transmitral flow wave velocities and their ratio (E/A), tissue Doppler indexes of the mitral annulus (Sa, Ea, Aa), and the E/Ea ratio. In addition, levels of high sensitivity C-reactive protein (hsCRP), tumour necrosis factor-alpha (TNF-alpha) and monocyte chemoattractant protein-1 (MCP-1) were measured from venous blood samples taken before, and 10 days, 3 months and 6 months after aortic valve replacement. RESULTS: LV mass decreased from 297 +/- 99.7 g before aortic valve replacement to 210 +/- 67 g 3 months after surgery and to 210 +/- 74 g 6 months after surgery (p<0.001). LV EF did not change significantly (p=0.836). Peak and mean systolic pressure gradients decreased, whereas aortic valve area increased after valve replacement (p<0.001). These changes were similar in men and women. In women Sa was greater (p=0.017) and the E/Ea ratio lower (p=0.025) than in men. The long-term changes in peak and mean pressure gradients, aortic valve area and LV mass after aortic valve replacement were well correlated with the long-term changes in hsCRP, TNF-alpha and MCP-1 in both men and women. CONCLUSIONS: LV remodelling is similar in elderly men and women with aortic valve disease who have similar body surface area. Although inflammatory markers are not correlated with echocardiographic parameters before aortic valve replacement, a strong correlation exists after operation. This correlation is similar in men and women.

Time course of C-reactive protein, tumour necrosis factor-alpha and monocyte chemoattractant protein-1 following the surgical treatment of patients with aortic valve stenosis.

INTRODUCTION: Patients with aortic valve stenosis show elevated levels of inflammatory markers in peripheral blood. The aim of this study was to investigate the time course of changes in these markers and to look for sex-related changes in their biological behaviour following aortic valve replacement. METHODS: We studied 52 patients (32 men, 20 women) who underwent aortic valve replacement and had no concomitant coronary artery disease. Men and women did not differ significantly with respect to age, body surface area, or body mass index. Levels of high sensitivity C-reactive protein (hsCRP), tumour necrosis factor-alpha (TNF-alpha) and monocyte chemoattractant protein-1 (MCP-1) were measured from venous blood samples taken before, and 10 days, 3 months and 6 months after aortic valve replacement. RESULTS: Baseline hsCRP levels were 5.34 +/- 5.71 mg/dl and 7.64 +/- 7.46 mg/dl for men and women, respectively. Levels increased significantly at 10 d (49.11 +/- 32.15 and 51.63 +/- 34.3 mg/dl, p < 0.001), then reduced at 3 m (5.85 +/- 5.04 and 8.49 +/- 7.69 mg/dl, p < 0.001) and 6 m (3.41 +/- 0.83 and 7.84 +/- 7.32 mg/dl, p < 0.001). Women had higher levels than men at 6 m (p = 0.027). Levels of TNF-alpha reduced progressively, from 212.4 +/- 119.5 and 255.7 +/- 171.3 pg/ml at baseline, to 121.6 +/- 47.7 and 150.0 +/- 33.5 pg/ml at 10 d, 134.7 +/- 25.3 and 138.6 +/- 30.9 at 3 m, and 48.7 +/- 8.8 and 44.9 +/- 10.5 pg/ml at 6 m (p < 0.001). MCP-1 levels also reduced progressively, from 157 +/- 64.8 and 145.6 +/- 13.4 pg/ml at baseline, to 128.6 +/- 18.8 and 122.7 +/- 10.3 pg/ml at 10 d, 49.0 +/- 12.4 and 56.6 +/- 11.5 pg/ml at 3 m, and 29.1 +/- 6.4 and 30.6 +/- 7.3 pg/ml at 6 m (p < 0.001). The time course of the changes in these indexes was identical for men and women, except that 6 m hsCRP levels were significantly higher in women. CONCLUSIONS: After aortic valve replacement, hsCRP levels show an early increase followed by a decrease, whereas both TNF-alpha and MCP-1 are reduced progressively. The time course curve is identical in men and women, except that hsCRP levels are higher in women than in men 6 months after aortic valve replacement.