835-6 The effect of a calcium sensitizer or an inotrope or none in chronic low output decompensated heart failure: Results from the calcium sensitizer or inotrope or none in low output heart failure study (CASINO)

Zairis, Michael N.; Apostolatos, Charalambos S.; Anastasiadis, Phillippos; Mytas, Dimitris; Katsaris, C.; Kouris, Nikolaos; Grassos, Hristos; Karidis, K.; Adamopoulou, Evdokia N.; Argyrakis, Spyros K.; Prekates, A.; Foussas, Stefanos

doi:10.1016/s0735-1097(04)90879-0

Cited by 44 publications

(30 citation statements)

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“…As far as comparison is possible, such outcomes appear to be in line with those which are reported in published clinical trials of levosimendan [15][16][17][18][19] and in a comprehensive meta-analysis [14], in particular with regards to shortened LOS; the gain of 1.5 days reported by Fedele et al [21] is the same as that reported by Landoni et al [14]. In other words, all these clinical findings appear to be confirmed by a "real-life" clinical experience in Italy.…”

Section: Discussionsupporting

confidence: 85%

Economic Evaluation of Levosimendan Versus Dobutamine for the Treatment of Acute Heart Failure in Italy

Lucioni¹,

D’Ambrosi

Mazzi³

et al. 2012

Adv Therapy

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Inodilators are the first-choice class of drugs for the treatment of acute heart failure (AHF). Levosimendan is a relatively recent inodilatory agent, presenting superior outcomes in comparison with traditional inotropes. An economic evaluation of levosimendan for the treatment of AHF in Italy was performed. In a retrospective study conducted on patients with AHF admitted to a teaching hospital in Rome, two groups were derived from an observational registry: 147 patients treated with levosimendan and 145 treated with dobutamine. Follow-up was at 1 year after treatment. In the reference study looked at in this paper, treatment with levosimendan reduced mean length of stay (LOS) by 1.5 days (P < 0.05). Reduction in the rehospitalization rate was 6.7% (P < 0.05). Mortality rate at 1 month was reduced by 4.8% (P < 0.05). Based on the reference study, a cost analysis from the hospital perspective was carried out. The incremental cost of treatment with levosimendan (a,not sign697) was equivalent to the incremental savings (a,not sign694), the latter being obtained from the reduction in LOS (a,not sign508) and rehospitalization rate (a,not sign186). Despite the limitations of this study, and even neglecting all nonmonetary health gains as additional outcomes, levosimendan appears to be a competitive alternative compared with dobutamine for the treatment of AHF in the Italian hospital setting

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Section: Discussionsupporting

confidence: 85%

Economic Evaluation of Levosimendan Versus Dobutamine for the Treatment of Acute Heart Failure in Italy

Lucioni¹,

D’Ambrosi

Mazzi³

et al. 2012

Adv Therapy

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“…In großen randomisierten Studien zeigten sich für Levosimendan bei Patienten mit einer "Low-output"-Herzinsuffizienz gegenüber der konventionellen Therapie eine Verbesserung der Makro-und Mikrohämodynamik, eine Milderung von Mü-digkeit und Dyspnoe sowie eine geringere Mortalität nach 180 Tagen (26 vs. 38%) [14,45,46,61,62,84,107]. Einen Überblick über experimentelle und klinische Studien zur Therapie der akuten und chronischen Herzinsuffizienz mit Levosimendan gibt .…”

Section: Akute Und Chronische Herzinsuffizienzunclassified

Role of Levosimendan in intensive care treatment of myocardial insufficiency

Rehberg¹,

Ertmer²,

Aken³

et al. 2007

Anaesthesist

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Levosimendan is a calcium sensitizer that is currently in the focus of intensive care medicine because it may be superior to standard inotropic agents in the treatment of acute myocardial insufficiency. The effects of levosimendan mainly depend on three predominant mechanisms: 1) positive inotropic effect by increasing the sensitivity of cardiac myofilaments to calcium ions, 2) vasodilatory effect by stimulation of adenosine triphosphate-sensitive potassium channels and 3) inhibition of phosphodiesterase-III. In a large number of experimental and clinical studies further possible indications for levosimendan have been described, e.g. cardioprotection during ischemia, cardiogenic shock, septic myocardial insufficiency and pulmonary hypertension. This review article critically summarizes the current scientific and clinical knowledge about levosimendan, its pharmacologic characteristics, mechanisms of action as well as indications and potential risks.

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“…The early diastolic portion of the LV pressure-volume (P-V) loop shifts upward and rightward during Ex after CHF. Thus any diastolic dysfunction present at rest in CHF is exacerbated during Ex (8,11).Levosimendan (LSM), a novel Ca 2ϩ sensitizer, is reported to be an inotropic and vasodilator agent without adverse effects on diastolic function (24,43,48,61,62). Unlike most other Ca 2ϩ sensitizers, LSM acts through direct binding with troponin C and increases the affinity of troponin C for Ca 2ϩ in a…”

mentioning

confidence: 99%

“…LSM improved the survival of patients with severe low-output CHF (15). In addition, LSM reduced the risks of worsening CHF and death in patients with CHF (35,62). Although beneficial effects of LSM in CHF at rest have been demonstrated, its effects during Ex are not known.…”

mentioning

confidence: 99%

Levosimendan improves LV systolic and diastolic performance at rest and during exercise after heart failure

Tachibana¹,

Cheng²,

Ukai³

et al. 2005

American Journal of Physiology-Heart and Circulatory Physiology

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The new myofilament Ca 2ϩ sensitizer levosimendan (LSM) is a positive inotropic and vasodilatory agent. Its beneficial effects have been demonstrated at rest in congestive heart failure (CHF). However, its effect during exercise (Ex) in CHF is unknown. We assessed the effects of LSM on left ventricular (LV) dynamics at rest and during Ex in eight conscious, instrumented dogs with pacing-induced CHF. After CHF, with dogs at rest, LSM decreased arterial elastance (E a) and increased LV contractile performance as assessed by the slope of LV pressure-volume (P-V) relation. LSM caused a Ͼ60% increase in the peak rate of mitral flow (dV/dtmax) due to decreases in minimal LV pressure and the time constant of LV relaxation (). LV arterial coupling, quantified as the ratio of end-systolic elastance (E es) to Ea, was increased from 0.47 to 0.85%. LV mechanical efficiency, determined as the ratio of stroke work to total P-V area, was improved from 0.54 Ϯ 0.09 to 0.61 Ϯ 0.07. These beneficial effects persisted during Ex after CHF. Compared with CHF Ex dogs, treatment with LSM prevented Ex-induced abnormal increases in mean left atrial pressure and end-diastolic pressure and decreased E es/Ea. With LSM treatment during CHF Ex, the early diastolic portion of the LV P-V loop was shifted downward with decreased minimal LV pressure and values and a further augmented dV/dtmax. Ees/Ea improved, and mechanical efficiency further increased from 0.61 Ϯ 0.07 to 0.67 Ϯ 0.07, which was close to the value reached during normal Ex. After CHF, LSM produced arterial vasodilatation; improved LV relaxation and diastolic filling; increased contractility, LV arterial coupling, and mechanical efficiency; and normalized the response to Ex.congestive heart failure; left ventricular dynamics; filling; contractility; mechanical efficiency IMPORTANT GOALS IN THE TREATMENT of patients with congestive heart failure (CHF) are to prolong survival and improve the patient's quality of life. The major symptom and cause of disability in CHF patients is exercise (Ex) intolerance (5,32,45). Observational work in the general healthy population has shown that Ex capacity is a more powerful prognostic indicator than traditional risk factors for cardiovascular disease (36, 44). However, despite enormous advances in the understanding and treatment of CHF that have taken place during the last 50 years, CHF remains a serious and, in fact, growing health problem. Present treatment of Ex intolerance is unsatisfactory in CHF patients (45,63). The ␤-adrenergic agonist dobutamine and phosphodiesterase inhibitor milrinone were associated with worse survival and clinical outcomes and did not improve quality of life for severe CHF patients (42, 48). Angiotensinconverting enzyme inhibitor therapy and ␤-blockade treatment improve survival in patients with CHF but do not always enhance Ex tolerance (37). Recently myofilament Ca 2ϩ sensitizers, which are a new class of nonglycosidic, nonadrenergic, positive inotropic agents, have been studied in patients with CHF. Because impair...

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835-6 The effect of a calcium sensitizer or an inotrope or none in chronic low output decompensated heart failure: Results from the calcium sensitizer or inotrope or none in low output heart failure study (CASINO)

Cited by 44 publications

References 0 publications

Economic Evaluation of Levosimendan Versus Dobutamine for the Treatment of Acute Heart Failure in Italy

Economic Evaluation of Levosimendan Versus Dobutamine for the Treatment of Acute Heart Failure in Italy

Role of Levosimendan in intensive care treatment of myocardial insufficiency

Levosimendan improves LV systolic and diastolic performance at rest and during exercise after heart failure

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