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Synergistic Effects of Moderate Therapeutic Hypothermia and Levosimendan on Cardiac Function and Survival After Asphyxia‐Induced Cardiac Arrest in Rats
BACKGROUND: This study investigated whether levosimendan, an inotropic calcium sensitizer, when combined with moderate therapeutic hypothermia, may exert synergistic benefits on post–cardiac arrest myocardial dysfunction and improve outcomes. METHODS AND RESULTS: After 9.5‐minute asphyxia‐induced ca...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7429058/ https://www.ncbi.nlm.nih.gov/pubmed/32476598 http://dx.doi.org/10.1161/JAHA.120.016139 |
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author | Wang, Chih‐Hung Chang, Wei‐Tien Tsai, Min‐Shan Huang, Chien‐Hua Chen, Wen‐Jone |
author_facet | Wang, Chih‐Hung Chang, Wei‐Tien Tsai, Min‐Shan Huang, Chien‐Hua Chen, Wen‐Jone |
author_sort | Wang, Chih‐Hung |
collection | PubMed |
description | BACKGROUND: This study investigated whether levosimendan, an inotropic calcium sensitizer, when combined with moderate therapeutic hypothermia, may exert synergistic benefits on post–cardiac arrest myocardial dysfunction and improve outcomes. METHODS AND RESULTS: After 9.5‐minute asphyxia‐induced cardiac arrest and resuscitation, 48 rats were randomized equally into 4 groups following return of spontaneous circulation (ROSC), including normothermia, hypothermia, normothermia–levosimendan, and hypothermia–levosimendan groups. For the normothermia group, the target temperature was 37°C while for the hypothermia group, the target temperature was 32°C, both of which were to be maintained for 4 hours after ROSC. Levosimendan was administered after ROSC with a loading dose of 10 μg/kg and then infused at 0.1 μg/kg per min for 4 hours. In the hypothermia–levosimendan group, left ventricular systolic function and cardiac output increased significantly, whereas the heart rate and systemic vascular resistance decreased significantly compared with the normothermia group. Also, the concentrations of interleukin 1β at 4 hours post‐ROSC and the production of NO between 1 hour and 4 hours post‐ROSC were reduced significantly in the hypothermia–levosimendan group compared with the normothermia group. The 72‐hour post‐ROSC survival and neurological recovery were also significantly better in the hypothermia–levosimendan group compared with the normothermia group (survival, 100% versus 50%, χ(2) test, P=0.006). CONCLUSIONS: Compared with normothermia, only combined moderate therapeutic hypothermia and levosimendan treatment could consistently improve post–cardiac arrest myocardial dysfunction and decrease the release of pro‐inflammatory molecules, thereby improving survival and neurological outcomes. These findings suggest synergistic benefits between moderate therapeutic hypothermia and levosimendan. |
format | Online Article Text |
id | pubmed-7429058 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-74290582020-08-18 Synergistic Effects of Moderate Therapeutic Hypothermia and Levosimendan on Cardiac Function and Survival After Asphyxia‐Induced Cardiac Arrest in Rats Wang, Chih‐Hung Chang, Wei‐Tien Tsai, Min‐Shan Huang, Chien‐Hua Chen, Wen‐Jone J Am Heart Assoc Original Research BACKGROUND: This study investigated whether levosimendan, an inotropic calcium sensitizer, when combined with moderate therapeutic hypothermia, may exert synergistic benefits on post–cardiac arrest myocardial dysfunction and improve outcomes. METHODS AND RESULTS: After 9.5‐minute asphyxia‐induced cardiac arrest and resuscitation, 48 rats were randomized equally into 4 groups following return of spontaneous circulation (ROSC), including normothermia, hypothermia, normothermia–levosimendan, and hypothermia–levosimendan groups. For the normothermia group, the target temperature was 37°C while for the hypothermia group, the target temperature was 32°C, both of which were to be maintained for 4 hours after ROSC. Levosimendan was administered after ROSC with a loading dose of 10 μg/kg and then infused at 0.1 μg/kg per min for 4 hours. In the hypothermia–levosimendan group, left ventricular systolic function and cardiac output increased significantly, whereas the heart rate and systemic vascular resistance decreased significantly compared with the normothermia group. Also, the concentrations of interleukin 1β at 4 hours post‐ROSC and the production of NO between 1 hour and 4 hours post‐ROSC were reduced significantly in the hypothermia–levosimendan group compared with the normothermia group. The 72‐hour post‐ROSC survival and neurological recovery were also significantly better in the hypothermia–levosimendan group compared with the normothermia group (survival, 100% versus 50%, χ(2) test, P=0.006). CONCLUSIONS: Compared with normothermia, only combined moderate therapeutic hypothermia and levosimendan treatment could consistently improve post–cardiac arrest myocardial dysfunction and decrease the release of pro‐inflammatory molecules, thereby improving survival and neurological outcomes. These findings suggest synergistic benefits between moderate therapeutic hypothermia and levosimendan. John Wiley and Sons Inc. 2020-06-01 /pmc/articles/PMC7429058/ /pubmed/32476598 http://dx.doi.org/10.1161/JAHA.120.016139 Text en © 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
spellingShingle | Original Research Wang, Chih‐Hung Chang, Wei‐Tien Tsai, Min‐Shan Huang, Chien‐Hua Chen, Wen‐Jone Synergistic Effects of Moderate Therapeutic Hypothermia and Levosimendan on Cardiac Function and Survival After Asphyxia‐Induced Cardiac Arrest in Rats |
title | Synergistic Effects of Moderate Therapeutic Hypothermia and Levosimendan on Cardiac Function and Survival After Asphyxia‐Induced Cardiac Arrest in Rats |
title_full | Synergistic Effects of Moderate Therapeutic Hypothermia and Levosimendan on Cardiac Function and Survival After Asphyxia‐Induced Cardiac Arrest in Rats |
title_fullStr | Synergistic Effects of Moderate Therapeutic Hypothermia and Levosimendan on Cardiac Function and Survival After Asphyxia‐Induced Cardiac Arrest in Rats |
title_full_unstemmed | Synergistic Effects of Moderate Therapeutic Hypothermia and Levosimendan on Cardiac Function and Survival After Asphyxia‐Induced Cardiac Arrest in Rats |
title_short | Synergistic Effects of Moderate Therapeutic Hypothermia and Levosimendan on Cardiac Function and Survival After Asphyxia‐Induced Cardiac Arrest in Rats |
title_sort | synergistic effects of moderate therapeutic hypothermia and levosimendan on cardiac function and survival after asphyxia‐induced cardiac arrest in rats |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7429058/ https://www.ncbi.nlm.nih.gov/pubmed/32476598 http://dx.doi.org/10.1161/JAHA.120.016139 |
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