Levosimendan in patients with low-output heart failure: lessons from the LIDO trial.
The novel calcium sensitizer levosimendan improves myocardial contractility without causing an increase in intracellular calcium and cyclic adenosine monophosphate concentrations. It also has a vasodilator action due to an opening of the adenosine triphosphate-sensitive potassium channels. In a double-blind clinical trial levosimendan was compared with dobutamine in 203 patients with severe low-output congestive heart failure. A 24-hour infusion of these inotropic drugs was administered to increase the cardiac output by at least 30% together with a decrease in the pulmonary capillary wedge pressure by > or = 25%. The pre-defined hemodynamic improvement was achieved in 28% of patients receiving levosimendan compared to only 15% with dobutamine (p = 0.022). Levosimendan also reduced the 1- and 6-month mortality more than dobutamine (7.8 vs 17%, p = 0.045 and 26 vs 38%, p = 0.029, respectively). Levosimendan produced less myocardial ischemia and cardiac arrhythmias than dobutamine. Calcium sensitizers offer a new therapeutic possibility in patients with decompensated low-output heart failure.
Follath
Ferenc
F
Department of Internal Medicine, University Hospital, Ramistrasse 100, 8091 Zurich, Switzerland. ferenc.follath@usz.ch
D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D020746:Calcium Channels, L-Type / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002303:Cardiac Output, Low / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D004280:Dobutamine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005060:Europe / Q000453:epidemiology; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D009017:Morbidity; D009200:Myocardial Contraction / Q000187:drug effects; D011669:Pulmonary Wedge Pressure / Q000187:drug effects; D011724:Pyridazines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012307:Risk Factors; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D000077464:Simendan; D013318:Stroke Volume / Q000187:drug effects; D016019:Survival Analysis; D013995:Time; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology
D000318:Adrenergic beta-Agonists; D020746:Calcium Channels, L-Type; D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D014665:Vasodilator Agents; D000077464:Simendan; D004280:Dobutamine