The role of levosimendan in the treatment of acute heart failure

Abstract:

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