Inoprotection: the perioperative role of levosimendan.
Levosimendan is emerging as a novel cardioprotective inotrope. Levosimendan augments myocardial contractility by sensitising contractile myofilaments to calcium without increasing myosin adenosine triphosphatase activity or oxygen consumption. Levosimendan activates cellular adenosine triphosphate-dependent potassium channels, a mechanism which is postulated to protect cells from ischaemia in a manner similar to ischaemic preconditioning. Levosimendan may therefore protect the ischaemic myocardium during ischaemia-reperfusion as well as improve the contractile function of the heart. Adenosine triphosphate-dependent potassium channel activation by levosimendan may also be protective in other tissues, such as coronary vascular endothelium, kidney and brain. Clinical trials in patients with decompensated heart failure and myocardial ischaemia show levosimendan to improve haemodynamic performance and potentially improve survival. This paper reviews the known pharmacology of levosimendan, the clinical experience with the drug to date and the potential use of levosimendan as a cardioprotective agent during surgery.
Soeding
P E
PE
Cardiovascular Therapeutics Unit, Department of Pharmacology, University of Melbourne, Melbourne, Victoria, Australia.
Royse
C F
CF
Wright
C E
CE
Royse
A G
AG
Angus
J A
JA
D000818:Animals; D002316:Cardiotonic Agents / Q000378:metabolism / Q000494:pharmacology / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D001026:Coronary Artery Bypass; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D006835:Hydrazones / Q000378:metabolism / Q000494:pharmacology / Q000627:therapeutic use; D019157:Ischemic Preconditioning, Myocardial / Q000379:methods*; D009200:Myocardial Contraction / Q000187:drug effects*; D019990:Perioperative Care / Q000379:methods*; D015221:Potassium Channels / Q000187:drug effects; D011724:Pyridazines / Q000378:metabolism / Q000494:pharmacology / Q000627:therapeutic use; D000077464:Simendan
D002316:Cardiotonic Agents; D006835:Hydrazones; D015221:Potassium Channels; D011724:Pyridazines; D000077464:Simendan