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Cardiovasc Drugs Ther. 2018 Dec;32(6):617-624. doi: 10.1007/s10557-018-6838-2.

Levosimendan in Acute and Advanced Heart Failure: an Expert Perspective on Posology and Therapeutic Application.

Author information

1
Department of Anesthesiology, University Hospital, Ghent, Belgium.
2
Policlinico "Umberto I," University "La Sapienza", Rome, Italy.
3
Aristotle University of Thessaloniki, Thessaloniki, Greece.
4
Cardiology, Rigshospitalet, Copenhagen, Denmark.
5
Cardiology Clinic, HUS Meilahti Hospital, Helsinki, Finland.
6
Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
7
Critical Care Proprietary Products Division, Orion Pharma, P.O. Box 65, FIN-02101, Espoo, Finland.
8
Department of Cardiology S7, Jorvi Hospital, Espoo, Finland.
9
Myokardiale Energetik und Metabolismus Research Unit, Medical University, Graz, Austria.
10
Niguarda Ca'Granda Hospital, Milan, Italy.
11
Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
12
Second University Cardiology Clinic, Attiko Teaching Hospital, Athens, Greece.
13
Critical Care Proprietary Products Division, Orion Pharma, P.O. Box 65, FIN-02101, Espoo, Finland. piero.pollesello@gmail.com.
14
Universitätsklinik für Innere Medizin III Innsbruck, Medizinsche Universität, Innsbruck, Austria.
15
Berlin Center for Regenerative Therapies (BCRT), Campus Virchow Klinikum (CVK), Berlin, Germany.

Abstract

Levosimendan, a calcium sensitizer and potassium channel-opener, is widely appreciated by many specialist heart failure practitioners for its effects on systemic and pulmonary hemodynamics and for the relief of symptoms of acute heart failure. The drug's impact on mortality in large randomized controlled trials has been inconsistent or inconclusive but, in contrast to conventional inotropes, there have been no indications of worsened survival and some signals of improved heart failure-related quality of life. For this reason, levosimendan has been proposed as a safer inodilator option than traditional agents in settings, such as advanced heart failure. Positive effects of levosimendan on renal function have also been described. At the HEART FAILURE 2018 congress of the Heart Failure Association of the European Society of Cardiology, safe and effective use levosimendan in acute and advanced heart failure was examined in a series of expert tutorials. The proceedings of those tutorials are summarized in this review, with special reference to advanced heart failure and heart failure with concomitant renal dysfunction. Meta-analysis of clinical trials data is supportive of a renal-protective effect of levosimendan, while physiological observations suggest that this effect is exerted at least in part via organ-specific effects that may include selective vasodilation of glomerular afferent arterioles and increased renal blood flow, with no compromise of renal oxygenation. These lines of evidence require further investigation and their clinical significance needs to be evaluated in specifically designed prospective trials.

KEYWORDS:

Acute heart failure; Advanced heart failure; Inodilators; Inotropes; Levosimendan; Renal function

PMID:
30402660
PMCID:
PMC6267661
DOI:
10.1007/s10557-018-6838-2
[Indexed for MEDLINE]
Free PMC Article

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