Comparison between milrinone and levosimendan infusion in patients with peripartum cardiomyopathy

Introduction Peripartum cardiomyopathy (PPCM) is a rare disorder of dilated cardiomyopathy in which no other cause of heart dysfunction can be identified within the final trimester of pregnancy or within 5 months after delivery. The aim of this prospective study was to assess the effect of 24-h infusion of levosimendan compared with milrinone on cardiac function and patient outcome. Patients and methods All patients enrolled in the study fulfilled the diagnostic criteria of PPCM. Patients were allocated randomly into one of two groups (15 patients each): group A received levosimendan infusion (a loading dose of 12 μg/kg intravenously for 10 min, followed by an intravenous infusion 0.1–0.2 μg/kg/min) and group B received milrinone infusion (a loading dose of 50 μg/kg administered intravenously for 10 min, followed by an intravenous infusion at a dosage titrated between 0.375 and 0.750 μg/kg/min) for 24 h after delivery. Hemodynamic and cardiac function parameters [stroke volume (SV), cardiac output (CO), and systemic vascular resistance] were monitored every 6 h for 24 h; also, cardiac biomarkers were monitored every 2 days thereafter until the day of discharge. Results No significant difference was found in hemodynamic parameters between group A and group B. Milrinone-treated patients showed a significant increase in CO parameters (SV and cardiac index) compared with the levosimendan group; yet, no significant difference was found in systemic vascular resistance between the two study groups. Also, no significant differences were found in cardiac biomarkers or outcome prognosis parameters between milrinone and levosimendan groups. Conclusion PPCM is an uncommon, but life-threatening condition. Despite the significant improvement in CO parameters (SV and cardiac index) in milrinone-treated patients, there was no significant difference in hemodynamic parameters, cardiac biomarkers levels, and outcome prognosis compared with levosimendan infusion. This study paves the way for further researches to establish an optimized protocol for the management of such a challenging condition.