Levosimendan, a new inotropic and vasodilator drug

Abstract

Traditional positive inotropic agents, such as ß-adrenergic agonists, exert their effects by increasing intracellular calcium concentrations, which may enhance myocardial energy consumption, promote cardiotoxicity and cardiomyocyte death, induce fatal arrhythmias and increase mortality. Levosimendan, a novel calcium sensitiser, may improve cardiac performance and symptoms without promoting intracellular calcium overloading, increasing oxygen consumption, or causing myocardial injury. Levosimendan has a dual mechanism of action: 1) improvedcalcium myofilament responsiveness that enhances contractility and 2) ATP-sensitive potassium channels activation that causes vaodilatation, improves myocardial perfusion, and activates stunned myocardium. Preliminary observations suggest that a single 24-hour infusion of levosimendan in patients with severe heart failure due to left ventricular systolic dysfunction results in beneficial hemodynamic changes, relief of symptoms and reduction in short-term morbidity and mortality. It seems that levosimendan also has anti-inflammatory and anti-apoptotic properties. Since 2001 levosimendan has been approved for treatment of acute decompensation of heart failure in more than 40 countries and it was introduced in the new guidelines of the European Society of Cadiology for the treatment of acute heart failure syndrome (IIa,B). Levosimendan is under investigation in low cardiac output and cardiogenic shock after myocardial infarction or angioplasty, in cardiac surgery, sepsis and septic shock as well as post-resuscitation.

Key words: heart failure, inotrope, vasodilator agents, hemodynamics, levosimendan

Levosimendanul, un nou medicament inotrop-pozitiv şi vasodilatator

Jurnalul Român de Anestezie Terapie intensivă 2007 Vol.14 Nr.1, 50-56