A review of levosimendan in the treatment of heart failure.
Heart failure is a relatively important public health problem due to its increasing incidence, poor prognosis, and frequent need of re-hospitalization. Intravenous positive inotropic agents play an important role in treating acute decompensation of patients with heart failure due to left ventricular systolic dysfunction. Although frequently used, the inotropic agents beta-adrenergic agonists and phosphodiesterase inhibitors seem effective for improving symptoms in the short term; it has been shown that they increase morbidity and mortality by elevating intracellular cyclic adenosine monophosphate (cAMP) and calcium levels. Levosimendan is a new positive inotropic agent having ATP-dependent potassium-channel-opening and calcium-sensitizing effects. In studies on its effects without increasing intracellular calcium concentrations and on its effects that depend on available intracellular calcium levels, it has been shown to have favorable characteristics different from those of current inotropic agents, which exert their effects by increasing calcium concentrations. This study aims to review other important studies about levosimendan by revealing the underlying mechanisms of its activity, efficiency, and safety.
Kasikcioglu
Hulya Akhan
HA
Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey. hulyakasikcioglu@yahoo.com
Cam
Nese
N
D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003326:Coronary Circulation / Q000187:drug effects; D004359:Drug Therapy, Combination; D006333:Heart Failure / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use*; D020782:Matrix Metalloproteinases / Q000378:metabolism; D009200:Myocardial Contraction / Q000187:drug effects; D017682:Myocardial Stunning / Q000188:drug therapy; D009490:Neurosecretory Systems / Q000187:drug effects; D017410:Practice Guidelines as Topic; D011724:Pyridazines / Q000627:therapeutic use*; D000077464:Simendan; D016896:Treatment Outcome; D020257:Ventricular Remodeling / Q000187:drug effects
D000889:Anti-Arrhythmia Agents; D000893:Anti-Inflammatory Agents; D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan; D020782:Matrix Metalloproteinases