An emerging role for calcium sensitisation in the treatment of heart failure.
Heart failure occurs in 2 - 3% of the adult population in the developed world. With decompensation of cardiac function, haemodynamic stability can be achieved by using intravenous vasodilators, diuretics and inotropes. Unlike traditional inotropes, Ca2+ sensitisers enhance cardiac function without significantly increasing cardiac oxygen consumption, promoting arrhythmia or impairing lusitropy. The most promising drug in this new class is levosimendan, which has a unique dual mechanism; it enhances cardiac output through a Ca(2+)-dependent stabilisation of cardiac myofilaments and exhibits vasodilatory effects by opening ATP-dependent K(+) channels. Clinical trials have demonstrated the beneficial haemodynamic effects of levosimendan, and prospective trials are currently underway to confirm its potential benefits on long-term prognosis. Updated guidelines from the European Society of Cardiology advise on how to incorporate levosimendan into care for patients who have acute heart failure.
Erhardt
Leif
L
Lund University, Malmö University Hospital, 205 02 Malmö, Sweden. Leif.Erhardt@medforsk.mas.lUSe
D000818:Animals; D020013:Calcium Signaling / Q000187:drug effects* / Q000502:physiology; D002986:Clinical Trials as Topic / Q000639:trends; D015507:Drugs, Investigational / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use*; D006333:Heart Failure / Q000188:drug therapy* / Q000378:metabolism; D006801:Humans; D006835:Hydrazones / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use; D032383:Myocytes, Cardiac / Q000187:drug effects / Q000502:physiology; D011724:Pyridazines / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use; D000077464:Simendan
D015507:Drugs, Investigational; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan