Levosimendan

Figgitt, David P.; Gillies, Peter S.; Goa, Karen L.

doi:10.2165/00003495-200161050-00006

Cited by 129 publications

(107 citation statements)

References 50 publications

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“…In 972 patients treated with intravenous levosimendan in the initial clinical trials, headache occurred in 8.7% and hypotension in 6.5% of patients. 31 Among the laboratory parameters, slight reductions in red blood cell count, hematocrit, and hemoglobin (Ͻ10%), as well as small reductions of serum potassium, were also described in 5% of patients. In contrast, serum creatinine levels significantly improved, even in patients with initially reduced renal function.…”

Section: Tolerabilitymentioning

confidence: 97%

European Experience on the Practical Use of Levosimendan in Patients with Acute Heart Failure Syndromes

Folláth

Franco

Silva-Cardoso

2005

The American Journal of Cardiology

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The novel calcium sensitizer and ATP-dependent potassium channel opener levosimendan has been introduced for routine use in several European countries. Recent reports on clinical experience confirm the positive hemodynamic results and beneficial clinical effects described in the initial dose-finding and randomized comparative therapeutic trials in patients with severe low-output heart failure. In addition, studies in small series of patients with cardiogenic shock after myocardial infarction and/or surgical interventions and postinterventional myocardial dysfunction ( Levosimendan is a new calcium-sensitizing drug that opens adenosine triphosphate-dependent potassium (K ATP ) channels with effects that increase myocardial contraction and cause vasodilation. Compared with other agents for acute heart failure syndromes (AHFS), its main potential advantages are the improvement of myocardial contractility without increasing oxygen requirements, reduction of ventricular preload, and an antistunning, anti-ischemic effect by opening K ATP channels. [1][2][3] This pharmacologic profile of levosimendan offers new therapeutic possibilities in patients with AHFS. In initial dose-finding 4,5 and therapeutic trials, 6 a rapid and prolonged hemodynamic improvement with an increase in cardiac index, reduction of pulmonary capillary wedge pressure (PCWP), and reduction of peripheral vascular resistance without proarrhythmic effects were documented. Furthermore, positive effects on long-term survival up to 6 months were observed. 6,7 Levosimendan is registered for clinical use in several countries in Europe, South America, and Asia. There are an increasing number of reports on practical experiences and therapeutic successes in different clinical situations. In this article, we summarize recent publications on therapeutic indications, dose schedules, outcomes, and tolerance. MethodsClinical reports on levosimendan therapy in patients with severe decompensated acute or chronic heart failure (HF), cardiogenic shock after myocardial infarction (MI), or cardiac interventions and perioperative administration are reviewed. These publications were mostly smaller randomized or observational trials, with good descriptions of patient inclusion criteria, levosimendan administration, and methods of clinical and/or hemodynamic evaluation. Therapeutic Efficacy of Levosimendan in Acute Heart Failure SyndromesDecompensated low-output heart failure: Decompensated low-output HF is the best documented therapeutic indication for levosimendan administered as a single intravenous infusion lasting 6 to 24 hours. Patients included in the dose-finding and comparative clinical trials 4 -6 were characterized by dyspnea (New York Heart Association [NYHA] functional class III to IV) and signs of venous and pulmonary congestion accompanied by peripheral vasoconstriction. Hemodynamic inclusion criteria were reduced cardiac index (Ͻ2.5 L/min per m 2 ) and increased PCWP (Ͼ16 mm Hg). Patients with systolic blood pressure Ͻ90 mm Hg were excluded in these initial ...

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Section: Tolerabilitymentioning

confidence: 97%

European Experience on the Practical Use of Levosimendan in Patients with Acute Heart Failure Syndromes

Folláth

Franco

Silva-Cardoso

2005

The American Journal of Cardiology

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“…Levosimendanın aritmojenik etkilerini değerlendiren plasebo kontrollü çalışmalar bulunmasına karşın, levosimendan ile dobutamin aritmojeniteleri açısından karşılaştıran veriler genellikle levosimendanın mortalite ve klinik etkinliğine ilişkin yapılan çalışmalar sırasında gözlenen aritmilerin analizlerine dayanmaktadır (25)(26)(27)(28)(29)(30)(31). LIDO ve SURVIVE çalışmasında aritmi değer-lendirmeleri için Holter kaydı kullanılmamış, Tek ve ark.nın (25) yaptıkları çalışmada ise bu aritmileri değerlendirmek için Holter kaydı kullanılmış.…”

Section: Discussionunclassified

“…Levosimendan ile yapılan birçok klinik çalışmada, supraventriküler taşikardi, ventriküler taşikardi ve proaritmi riski açısından levosimendanın standart tedaviden farksız olduğu gözlenmiştir (26)(27)(28)(29)(30)(31). Fakat daha sonra yapılan REVIVE II çalışmasında; akut dekompanse kalp yetersizlikli 600 hasta çalışmaya alınmış, standart tedaviye ek olarak levosimendan alan grup, standart tedaviyle birlikte plasebo alan grupla klinik bulgular ve semptomlar açısından karşılaştırılmıştır.…”

Section: Discussionunclassified

The effect of levosimendan and dobutamine treatment on QT dispersion in patients with decompensated heart failure: a prospective study

Paksoy¹,

Ulaş²,

Tursun³

et al. 2012

Anadolu Kardiyol Derg

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Objective: We investigated the effect of intravenous levosimendan on QT dispersion compared with intravenous dobutamine in patients with acute decompensated heart failure. Methods: This prospective cohort study included 38 patients who were admitted with acute decompensated heart failure (New York Heart Association functional class III-IV). Twenty-five patients (11 men, 14 women; mean age 70.5±11.13 years) were treated with levosimendan infusion and 13 patients (5 men, 8 women; mean age 71.08±6.86 years) were treated with dobutamine infusion. Intravenous levosimendan was administered with an initial bolus dose of 12 µg/kg for 10 min, followed by a continuous infusion of 0.1 µg/kg/min for 1 hour and 0.1 µg/kg/min 23 hours. Intravenous dobutamine was administered with a continuous dose of 10 µg/kg /min for 24 hours. Transthoracic echocardiography was performed and electrocardiograms were obtained before and after drug infusions. QTc dispersion was defined as the difference between the 16 ÖZET Amaç: Biz bu çalışmada, akut dekompanse kalp yetersizliği ile başvuran hastalarda levosimendan ve dobutamin infüzyonunun QT dispersiyonu üzerine olan etkisini araştırdık. Yöntemler: Bu prospektif kohort çalışmasında, akut dekompanse kalp yetersizliği tanısıyla yatırılan, New York Kalp Derneği (NYHA) sınıflama-sına göre sınıf III-IV kalp yetersizliği olan 38 hastadan, 25 hastaya (11'i erkek, 14'ü kadın, ortalama yaş: 70.5±11.13 yıl) levosimendan infüzyonu ve 13 hastaya (5'i erkek, 8'i kadın, ortalama yaş: 71.08±6.86 yıl) dobutamin infüzyonu verildi. İntravenöz levosimendan ilk 10 dakika 12 µg/kg/dk ile yükleme, sonraki 50 dakikada 0.1 µg/kg/dk, takiben 23 saatte ise 0.2 µg/kg/dk ile idame tedavisi şeklinde verildi. İntravenöz dobutamin ise 24 saat boyunca 10 mg/kg/dk dozunda verildi. İnfüzyon öncesi ve sonrasında hastaların transtorasik ekokardiyografileri yapıldı ve elektrokardiyografileri çekildi. QT dispersiyonu, maksimum QT ve minimum QT süresi arasındaki fark olarak tanımlandı ve bulunan değer kalp hızına göre düzeltildi. Verilerin analizinde Ki-kare Testi, Wilcoxon Testi ve Mann-Whitney U Testi kullanıldı. Bulgular: Hem levosimendan hem de dobutamin alan hasta grubunda, tedavi öncesi ve sonrasında kalp hızına göre düzeltilmiş minimum QT değerleri, maksimum QT değerleri ve QT dispersiyonları arasında istatistiksel olarak anlamlı fark bulunmadı (levosimendan grubunda sırası ile tedavi öncesi ve 24. saat değerleri 0.43±0.04 sn, 0.44±0.04 sn; 0.49±0.05 sn, 0.50±0.05 sn; 0.06±0.03 sn, 0.06±0.03 sn; dobutamin grubunda ise 0.39±0.05 sn, 0.41±0.05 sn; 0.45±0.05 sn, 0.48±0.05 sn; 0.06±0.04 sn, 0.06±0.04 sn) (p>0.05). Her iki tedavi grubunda takip süresince ilaçlara bağlı yan etki görülmedi. Sonuç: Tedavi dozlarında levosimendan infüzyonunun, dobutamin infüzyonu ile karşılaştırıldığında, akut dekompanse kalp yetersizliği hastaların-da aritmi gelişme olasılığının bir göstergesi olabilen QT parametreleri üzerine anlamlı bir etkisi görülmedi.

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“…Levosimendan is a new agent that exerts an inotropic effect through calcium sensitization acting on troponin C 64 . It also has vasodilating properties due to activation of ATP dependent potassium channels in the arterial wall.…”

Section: Levosimendanmentioning

confidence: 99%