Levosimendan in acute decompensation of anthracycline-induced cardiotoxicity

Abstract

A 42-year-old woman with metastatic breast cancer and previous normal cardiac function was treated during the last 2 years with chemotherapy regimens that included doxoru bicin (total dosage of 841 mg/m2 ). Four months after the last regimen, she was admitted to the ICU with decompensation of heart failure. She presented with severe dyspnea, anasarca and was dependent on supplemental oxygen. Chest radio graph showed bilateral pleural effusion and pulmonary edema. Transthoracic echocardiogram revealed severe diffuse myocardial dysfunction (left ventricular ejection fraction of 31%). The initial treatment included furosemide, spironolactone, deslanoside, non-invasive ventilation, ACE inhibitors and dobutamine (started at 8.3 mcg/kg/min). On the third day of ICU, patient's clinical condition did not improve and tachyarrhythmia arose after the increase of dobutamine dose (20 mcg/kg/min). Therefore, levosimendan was started at a dosage of 0.14 mcg/kg/min. Dobutamine was weaned and taken off within the first 12 h of levosimendan infusion. Two days later, patient's symptoms and clinical signs of heart failure improved; levosimendan was stopped after 48 h of infusion. She was discharged from the ICU on the following day and finally discharged home 1 month later.