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HWN Suggests

Levosimendan

Sure, there's plenty of data about the effects of levosimendan in healthy volunteers, but what intensivist could possibly give a flying hoot about those people. They tend to stay out of intensive care units, smoking drinking and making love in nightclubs. Our population of interest tends to trend older, featuring huge dilated ventricles, infarcted coronaries and dehisced sternal wounds. It is therefore more meaningful to describe what happens to a truly broken circulatory system when levosimendan is inflicted upon it.

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 Levosimendan in the light of the results of the recent randomized controlled trials: an expert opinion paper

Despite interesting and unique pharmacological properties, levosimendan has not proven a clear superiority to placebo in the patient populations that have been enrolled in the various recent multicenter randomized controlled trials. However, the pharmacodynamic effects of levosimendan are still considered potentially very useful in a number of specific situations.

Articles of Interest

An update on levosimendan in acute cardiac care: applications and recommendations for optimal efficacy and safety

Levosimendan can be a valuable resource in the treatment of acute cardiac dysfunction, especially in the presence of beta-blockers or ischemic cardiomyopathy. When attention is given to avoiding or correcting hypovolemia and hypokalemia, an early use of the drug in the treatment algorithm is preferred.

Levosimendan for the prevention of acute organ dysfunction in sepsis

Levosimendan is a calcium-sensitizing drug marketed under the trade name Simdax that is approved in Europe and South American for use in acute decompensated heart failure. It increases cardiac contractility through calcium sensitization of troponin C and vasodilates by opening potassium channels in vascular smooth muscle cells. It is felt to only minimally increase myocardial oxygen demand. Small trials have suggested that it may improve organ perfusion and hemodynamics in sepsis.

Levosimendan in intensive care and emergency medicine: literature update and expert recommendations for optimal efficacy and safety

The inodilator levosimendan, in clinical use for over two decades, has been the subject of extensive clinical and experimental evaluation in various clinical settings beyond its principal indication in the management of acutely decompensated chronic heart failure. Critical care and emergency medicine applications for levosimendan have included postoperative settings, septic shock, and cardiogenic shock.

Levosimendan versus dobutamine in critically ill patients: a meta-analysis of randomized controlled trials

In contrast with dobutamine, levosimendan is associated with a significant improvement in mortality in critically ill patients requiring inotropic support. Patients having cardiac surgery, with ischemic heart failure, and receiving concomitant β-blocker therapy may benefit from levosimendan.

Levosimendan: The current situation and new prospects

Although further studies are needed, current clinical evidence suggests that levosimendan is more effective than classical inotropes in improving cardiac mechanical efficiency and reducing congestion in acute HF patients without hypotension. Emerging new off-label uses in conditions such as PH and cardiac surgery may soon expand its clinical applicability. Further studies should be carried out in these patient groups.

Levosimendan: What Have We Learned So Far?

Preliminary data showed promising effects of levosimendan in patients with sepsis-related and stress-related (Takotsubo) myocardial dysfunction, in those difficult-to-wean from mechanical circulatory support and in ventilator-associated diaphragmatic dysfunction.

Overview of the current use of levosimendan in France: a prospective observational cohort study

Hypotension and atrial fibrillation remained the most frequent side-effects, while serious adverse event potentially attributable to levosimendan were infrequent. The results suggest that this medication was safe and potentially associated with some benefit in the population studied.

Use of levosimendan in acute heart failure

As a calcium sensitizer and inodilator that augments cardiac contractility without increasing myocardial oxygen demand or exacerbating ischaemia, levosimendan may be well configured to deliver inotropic support in cases of acute heart failure (AHF). Other factors favouring levosimendan in this setting include its extended duration of action due to the formation of an active metabolite and the lack of any attenuation of effect in patients treated with beta-blockers.

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Life in the Fastlane

Calcium sensitizer (novel inotrope, also considered an inodilator like milrinone).