MEDIX, God. 17 Br. 92/93  •  Pregledni članak  •  Kardiologija HR ENG

Mjesto levosimendana u liječenju akutnog zatajenja srcaThe role of levosimendan in the treatment of acute heart failure

Darko Počanić

Levosimendan je lijek za kritično bolesne osobe s akutnim zatajenjem srca, s trojnim učinkom: povećanjem osjetljivosti miocita na kalcijeve ione, otvaranjem kalijskih o ATP-u ovisnih kanalića u sarkolemi glatkih mišića perifernih arterija, ali i samih miofibrila. Na taj trojni način povećava srčanu snagu kontrakcije, mjerenu minutnim i udarnim volumenom, uz minimalni učinak na frekvenciju srca. Smanjuje se, također, plućni kapilarni tlak i periferni žilni otpor. Svi ovi učinci prolaze bez povećanja potrošnje kisika, tako da nema dodatnog oštećenja ionako oštećenog miokarda. Kliničke studije dokazale su visoku sigurnost primjene levosimendana, s povoljnim hemodinamičkim učincima, smanjenjem BNP-a, te kraćim hospitalizacijama, uz isto preživljenje bolesnika kao i u onih liječenih standardnom terapijom dobutaminom. Učinak levosimendana nije umanjen prethodnom kroničnom terapijom b- adrenergičnim blokatorima koji su često terapija bolesnika s kroničnim zatajivanjem srca. 

Ključne riječi:
kalcijska osjetljivost; simendan; zatajenje srca

Članak u cijelosti pročitajte u tiskanom izdanju MEDIX, God. 17 Br. 92/93

Levosimendan is a potent drug indicated for the treatment of acute congestive heart failure in critically ill patients. It exerts three mechanisms of action: calcium sensitisation, opening of ATP -sensitive potassium channels on the sarcolema of vascular smooth muscle cells and cardiomyocyte mitochondria. The result is improved cardiac contractility in failing heart, measured by cardiac output and stroke volume, with a minimal change in the heart rate. Pulmonary capillary wedge pressure is also decreased, as well as peripheral vascular resistance. Since these effects are not accompanied by increased oxygen consumption, there is no further damage to the myocardium. Clinical trials have shown that levosimendan has a good safety profile, leads to positive haemodynamic effects, reduces the level of brain natriuretic peptide and shortens in-hospital stay of levosimendan-treated patients, who have the same survival rates as those treated with standard of care, such as dobutamine. Levosimendan effects are not diminished by previous chronic treatment with .beta-blockers, which are frequently prescribed to patients with congestive heart failure. 

Key words:
heart failure; receptors, calcium-sensing; simendan