Levosimendan in Acute and Advanced Heart Failure: an Expert Perspective on Posology and Therapeutic Application

• Published in: Cardiovascular drugs and therapy Vol. 32; no. 6; pp. 617 - 624
• Main Authors: Bouchez, S., Fedele, F., Giannakoulas, G., Gustafsson, F., Harjola, V.-P., Karason, K., Kivikko, M., von Lewinski, D., Oliva, F., Papp, Z., Parissis, J., Pollesello, Piero, Pölzl, G., Tschöpe, C.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.12.2018; Springer Nature B.V
• Subjects: Acute Disease; Arterioles; Beta blockers; Blood flow; Calcium; Cardiac and Cardiovascular Systems; Cardiology; Cardiotonic Agents - adverse effects; Cardiotonic Agents - therapeutic use; Chronic Disease; Clinical trials; Congresses as Topic; Data processing; Dosage; Evidence-Based Medicine; Heart; Heart diseases; Heart failure; Heart Failure - diagnosis; Heart Failure - drug therapy; Heart Failure - mortality; Heart Failure - physiopathology; Hemodynamics; Humans; Kardiologi; Kidney - drug effects; Kidney - physiopathology; Medical research; Medicine; Medicine & Public Health; Myocardial Contraction - drug effects; Oxygenation; Physiological effects; Potassium; Quality of life; Recovery of Function; Renal failure; Renal function; Review; Review Article; Sensory neurons; Simendan - adverse effects; Simendan - therapeutic use; Time Factors; Treatment Outcome; Vasodilation; Vasodilator Agents - adverse effects; Vasodilator Agents - therapeutic use; Inotropes; Advanced heart failure; Renal function; Levosimendan; Inodilators; Acute heart failure
• ISSN: 0920-3206; 1573-7241; 1573-7241
• DOI: 10.1007/s10557-018-6838-2

Levosimendan, a calcium sensitizer and potassium channel-opener, is widely appreciated by many specialist heart failure practitioners for its effects on systemic and pulmonary hemodynamics and for the relief of symptoms of acute heart failure. The drug’s impact on mortality in large randomized controlled trials has been inconsistent or inconclusive but, in contrast to conventional inotropes, there have been no indications of worsened survival and some signals of improved heart failure-related quality of life. For this reason, levosimendan has been proposed as a safer inodilator option than traditional agents in settings, such as advanced heart failure. Positive effects of levosimendan on renal function have also been described. At the HEART FAILURE 2018 congress of the Heart Failure Association of the European Society of Cardiology, safe and effective use levosimendan in acute and advanced heart failure was examined in a series of expert tutorials. The proceedings of those tutorials are summarized in this review, with special reference to advanced heart failure and heart failure with concomitant renal dysfunction. Meta-analysis of clinical trials data is supportive of a renal-protective effect of levosimendan, while physiological observations suggest that this effect is exerted at least in part via organ-specific effects that may include selective vasodilation of glomerular afferent arterioles and increased renal blood flow, with no compromise of renal oxygenation. These lines of evidence require further investigation and their clinical significance needs to be evaluated in specifically designed prospective trials.