Levosimendan in the treatment of patients with acute cardiac conditions: an expert opinion of the Association of Intensive Cardiac Care of the Polish Cardiac Society

Abstract

Levosimendan is a new inodilator which involves 3 main mechanisms: increases the calcium sensitivity of cardiomyocytes, acts as a vasodilator due to the opening of potassium channels, and has a cardioprotective effect. Levosimendan is mainly used in the treatment of acute decompensated heart failure (class IIb recommendation according to the European Society of Cardiology guidelines). However, numerous clinical trials indicate the validity of repeated infusions of levosimendan in patients with stable heart failure as a bridge therapy to heart transplantation, and in patients with accompanying right ventricular heart failure and pulmonary hypertension. Due to the complex mechanism of action, including the cardioprotective and anti aggregating effect, the use of levosimendan may be particularly beneficial in acute coronary syndromes, preventing the occurrence of acute heart failure. There are data indicating that levosimendan administered prior to cardiac surgery may improve outcomes in patients with severely impaired left ventricular function. The multidirectional mechanism of action also affects other organs and systems. The positive effect of levosimendan in the treatment of cardio renal and cardio hepatic syndromes has been shown. It has a safe and predictable profile of action, does not induce tolerance, and shows no adverse effects affecting patients survival or prognosis. However, with inconclusive results of previous studies, there is a need for a welldesigned multicenter randomized placebo controlled study, including an adequately large group of outpatients with chronic advanced systolic heart failure.

Efficacy and safety of levosimendan and dobutamine in heart failure: A systematic review and meta-analysis

“…In addition, there was a trend towards lower 6-month mortality on levosimendan. Taking into account the promising results of our meta-analysis and the cardioprotective effects of levosimendan demonstrated in multiple studies, there is a need for a well-designed multicenter randomized placebo-controlled study, including an adequately large group of outpatients with acute HF to ultimately determine the effect of levosimendan on long-term prognosis [8].…”

Acute-on-chronic pulmonary embolism-induced right ventricular failure salvaged by combined catheter-directed therapy and levosimendan infusion

“…We describe a life-threatening acute-on-chronic PE treated with CDT supported by levosimendan infusion. We showed that levosimendan may have favorable effects on RV contractility in acute settings [4][5].…”

A favorable alliance between repetitive use of levosimendan and advanced heart failure: Polish two-centered inpatient perspective in need of validation

“…Levosimendan, compared to other inotropes, reduces the signs and symptoms of HF [3,[5][6][7][8], and mortality [5,7,8]. However, metanalyses [9,10] and the SURVIVE study [11] showed that levosimendan does not reduce mortality.…”