Levosimendan in acute heart failure

Husedžinović, Ino; Milanovic, Rudi; Husedzinovic, Sanja

doi:10.22514/sv31.022008.3

Cited by 4 publications

(6 citation statements)

References 10 publications

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“…This is a distinctive feature of levosimendan compared with all other inotropic agents, which increase the concentration of ionic free calcium in cardiomyocytes, exposing them to lethal concentrations of ionic calcium. Elevated intracellular ionic calcium has been associated with cardiac remodeling, arrhythmia, and increase in oxygen consumption 12,21,22. Even with its direct effects of increasing myocardial contractility and enhancing rapid ventricular filling, levosimendan does not affect left ventricular relaxation 23…”

Section: Levosimanden: Mechanism Of Actionmentioning

confidence: 99%

“…Metabolite OR1896 has comparable hemodynamic and pharmacologic effects to levosimendan, but unlike the parent drug, the elimination half-life is greatly extended to about 80 hours from 1 hour, thus further providing its cardiovascular therapeutic effects for several days, even after discontinuation of a 24 hour infusion of the parent drug 35. It is also important to note that the pharmacokinetics of levosimendan remain constant in patients with hepatic and renal impairment 12,36…”

Section: Pharmacokineticsmentioning

confidence: 99%

“…Excerpts from evidence-based guidelines provide a structure within which the potential role of levosimendan can be applied in the management of acute and advanced heart failure 12. Levosimendan is a calcium sensitizer and potassium-channel opener that has been proposed as a safer positive inotropic agent with peripheral vasodilator properties compared with traditional agents in acute and advanced heart failure.…”

Section: Introductionmentioning

confidence: 99%

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<p>Use of levosimendan in acute and advanced heart failure: short review on available real-world data</p>

Pashkovetsky¹,

Gupta²,

Aronow³

2019

TCRM

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Published data have shown potential advantages of levosimendan in the management of acute decompensated heart failure and advanced heart failure when standard medical therapies threaten hemodynamics and organ perfusion are unable to alleviate clinical symptoms. Levosimendan distinguishes itself from other catecholaminergic inotropes by its three mechanisms of action: positive inotropy, vasodilation, and cardioprotection. In addition, its pharmacokinetics allow for a longer duration of action from the metabolite OR1896 allowing for further cardiovascular therapeutic effects for several days, even after discontinuation of the parent drug.

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Section: Levosimanden: Mechanism Of Actionmentioning

confidence: 99%

Section: Pharmacokineticsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

<p>Use of levosimendan in acute and advanced heart failure: short review on available real-world data</p>

Pashkovetsky¹,

Gupta²,

Aronow³

2019

TCRM

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“…Thus, they decrease both preload and afterload, increase coronary circulation, and result in antiischemic effect. It is classified as an inotropic agent with anti-ischemic property [11].…”

Section: Levosimendanmentioning

confidence: 99%

Pharmacotherapy of Heart Failure

Vittalrao

Thanusubramanian

et al. 2018

Asian J Pharm Clin Res

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Heart failure (HF) is one of the major problems related to heart diseases in the modern era. Multiple comorbidities such as coronary artery disease, hypertension, diabetes mellitus, and anemia have a great contribution in the development of HF. It is primarily two types systolic and diastolic HF. Insufficient or decreased pumping of the heart is systolic HF, whereas diastolic HF is because of lack of ability of the heart to relax or increased muscle inflexibility. The pathophysiology of HF is due to enhanced activity of sympathetic system, renin angiotensin system, and structural changes in the wall of ventricle. The two definite targets of medical treatment in HF are as follows: (1) Alleviation of obstructive (or) decreased output manifestations and replenishment of cardiac function. The drugs used are frusemide, thiazides, angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs), amrinone/milrinone, dopamine/dobutamine, levosimendan, digoxin, hydralazine, nitroprusside, nitrate, bisoprolol, metoprolol, nebivolol, and carvedilol.(2) Prevention of advancement of HF and extension of patient survival -drugs used are β blockers, ACE inhibitors/ARBs, spironolactone, and eplerenone.

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“…It is therefore categorized as an antischemic inotropic agent. [4] It shows beneficial immunomodulatory, anti-inflammatory, and antioxidant properties to improve cardiac performance in cardiac ischemia[5] and has been shown to have favorable effects on coronary blood flow as it overrides normal autoregulatory vasodilatory mechanism of coronary circulation. [6] Thus, levosimendan has a potential benefit for patients with myocardial oxygen imbalance and requiring inotropes during OPCABG surgery with low ejection fractions (EF).…”

Section: Introductionmentioning

confidence: 99%

Study of levosimendan during off-pump coronary artery bypass grafting in patients with LV dysfunction: A double-blind randomized study

Shah¹,

Sharma²,

Brahmbhatt³

et al. 2014

Indian J Pharmacol

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Objectives:Levosimendan is a calcium sensitizer drug which has been used in cardiac surgery for the prevention of postoperative low cardiac output syndrome (LCOS) and in difficult weaning from cardiopulmonary bypass (CPB). This study aims to evaluate perioperative hemodynamic effects of levosimendan pretreatment in patients for off-pump coronary artery bypass graft (OPCABG) surgery with low left ventricular ejection fractions (LVEF < 30%).Materials and Methods:Fifty patients undergoing OPCABG surgery with low LVEF (<30%) were enrolled in the study. Patients were randomly divided in two groups: Levosimendan pretreatment (Group L) and placebo pretreatment (Group C) of 25 each. Group L, patients received levosimendan infusion 200 μg/kg over 24 h and in Group C Patients received placebo. The clinical parameters measured before and after the drug administration up to 48 h were heart rate (HR; for the hour after drug infusion), cardiac index (CI), and pulmonary capillary wedge pressure (PCWP). The requirement of inotropes, intraaortic balloon pump (IABP), CPB, intensive care unit (ICU) stay, and hospital stay were also measured.Results:The patients in group L exhibited higher CI and PCWP during operative in early postoperative period as compared to control group C. Group L also had a less requirement for inotropes, CPB support and IABP with shorter ICU stay as well as hospital stay.Conclusion:Levosimendan pretreatment (24 h infusion) in patient for OPCABG with poor LVEF shows better outcomes and hemodynamics in terms of inotropes, CPB and IABP requirements. It also reduces ICU stay.

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Levosimendan in acute heart failure

Abstract: ABSTRACT

Cited by 4 publications

References 10 publications

<p>Use of levosimendan in acute and advanced heart failure: short review on available real-world data</p>

<p>Use of levosimendan in acute and advanced heart failure: short review on available real-world data</p>

Pharmacotherapy of Heart Failure

Study of levosimendan during off-pump coronary artery bypass grafting in patients with LV dysfunction: A double-blind randomized study

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