Uso de levosimendana em diversos quadros de insuficiência cardíaca aguda

Tavares, Miguel; Andrade, Ana Carolina Dias Viana de; Mebazaa, Alexandre

doi:10.1590/s0066-782x2008000300012

Cited by 3 publications

(5 citation statements)

References 65 publications

(62 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Levosimendan is a pyridazinone-dinitrile derivative molecule that increases troponin C affinity for Ca ?2 and stabilizes the conformation of troponin C. By improving the sensitivity of the contractile apparatus to intracellular calcium, levosimendan leads to positive inotropic properties without impairing ventricular relaxation or inducing cytosolic Ca ?2 overload [3,8,9,14,15]. Levosimendan binds to troponin C during systole, increasing the sensitivity of myofilaments to Ca 2?…”

Section: Inotropic Effectsmentioning

confidence: 99%

“…Moreover, levosimendan-induced vasodilation of the coronary vessels increases coronary blood flow and improves oxygen supply to the myocardium which might result in anti-ischemic effects. An additional mechanism is the reduction of sensitivity of contractile system to calcium in vascular smooth-muscle cells [1,3,8,14,15].…”

Section: Inotropic Effectsmentioning

confidence: 99%

“…Several studies have already been performed to verify the short-term hemodynamic and clinical effects of levosimendan in patients with AHFS, and the comparison with other inotropic agents, such as dobutamine [1,3,5,8,15]. The LIDO [20] trial (levosimendan vs. dobutamine in AHFS) was a double-blind parallel group trial that randomized 203 patients with AHFS defined as left ventricle ejection fraction (LVEF) \ 35%, cardiac index (CI) \ 2.5 l/min/m 2 and pulmonary capillary wedge pressure (PCWP) [ 15 mmHg.…”

Section: Clinical Usementioning

confidence: 99%

“…Moreover, in severe heart failure patients with a restrictive pattern of LV filling, levosimendan ameliorated both systolic and diastolic function via augmenting LV filling, stroke volume, cardiac output, deceleration time, and A wave, while it diminished pulmonary capillary wedge pressure (PCWP), E wave and atrial reversal. It was also found that the decrease in the early/late transmitral diastolic peak flow velocity (E/A) ratio and the increase in the isovolumetric relaxation time (IVRT) predict independently the increment of cardiac output, while independent predictors of the PCWP reduction are the increase in systolic/diastolic (S/D) ratio and the decrease in E/A ratio [15,49]. Similar findings were observed in patients with LV hypertrophy after aortic valve replacement for aortic stenosis, as long as levosimendan induced a direct positive lusitropic effect via reducing IVRT and improvement of LV filling [50].…”

Section: Effects On Diastolic Functionmentioning

confidence: 99%

See 3 more Smart Citations

Levosimendan: from basic science to clinical practice

et al. 2008

Self Cite

View full text Add to dashboard Cite

Levosimendan is a new cardiac enhancer that exerts positive inotropic effects on the failing heart mediated by calcium sensitization of contractile proteins as well as peripheral vasodilatory effects mediated by opening of ATP-sensitive potassium channels in vascular smooth-muscle cells. Levosimendan is the most well-studied calcium sensitizer in the real clinical practice, producing greater hemodynamic and symptomatic improvement in patients with acute heart failure syndromes (AHFS) than those with traditional inotropes. Immunomodulatory and anti-apoptotic properties of levosimendan may be an additional biologic mechanism that prevents further cytotoxic and hemodynamic consequences of abnormal immune and neurohormonal responses in AHFS. Recent mortality trials showed that levosimendan does not improve short- and long-term prognosis in AHFS in comparison to dobutamine or placebo. However, in patients with a previous history of CHF and on beta-blocker on admission, levosimendan seems to have a beneficial effect on short-term mortality. According to the recent guidelines of the European Society of Cardiology, levosimendan is indicated in patients with symptomatic low cardiac output HF secondary to cardiac systolic dysfunction without severe hypotension (Class IIa, Level of Evidence B).

show abstract

Section: Inotropic Effectsmentioning

confidence: 99%

Section: Inotropic Effectsmentioning

confidence: 99%

Section: Clinical Usementioning

confidence: 99%

Section: Effects On Diastolic Functionmentioning

confidence: 99%

See 2 more Smart Citations

Levosimendan: from basic science to clinical practice

et al. 2008

Self Cite

View full text Add to dashboard Cite

show abstract

“…Levosimendan is a pyridazinone dinitrile derivative with positive inotropic, lusitropic, and vasodilatory effects, that have beneficial effects on myocardial performance. [ 10 ] The drug is a calcium-channel sensitizer. Levosimendan improves cardiac contractility without increasing myocardial oxygen demand or promoting arrhythmiogenesis.…”

Section: Introductionmentioning

confidence: 99%

Inhaled levosimendan versus intravenous levosimendan in patients with pulmonary hypertension undergoing mitral valve replacement

Kundra¹,

Nagaraja²,

Bharathi³

et al. 2018

Ann Card Anaesth

View full text Add to dashboard Cite

Context:Inhaled levosimendan may act as selective pulmonary vasodilator and avoid systemic side effects of intravenous levosimendan, which include decrease in systemic vascular resistance (SVR) and systemic hypotension, but with same beneficial effect on pulmonary artery pressure (PAP) and right ventricular (RV) function.Aim:The aim of this study was to compare the effect of inhaled levosimendan with intravenous levosimendan in patients with pulmonary hypertension undergoing mitral valve replacement.Settings and Design:The present prospective randomized comparative study was conducted in a tertiary care hospital.Subjects and Methods:Fifty patients were randomized into two groups (n = 25). Group A: Levosimendan infusion was started immediately after coming-off of cardiopulmonary bypass and continued for 24 h at 0.1 mcg/kg/min. Group B: Total dose of levosimendan which would be given through intravenous route over 24 h was calculated and then divided into four equal parts and administered through inhalational route 6th hourly over 24 h. Hemodynamic profile (pulse rate, mean arterial pressure, pulmonary artery systolic pressure [PASP], SVR) and RV function were assessed immediately after shifting, at 1, 8, 24, and 36 h after shifting to recovery.Statistical Analysis Used:Intragroup analysis was done using paired student t-test, and unpaired student t-test was used for analysis between two groups.Results:PASP and RV-fractional area change (RV-FAC) were comparable in the two groups at different time intervals. There was a significant reduction in PASP and significant improvement in RV-FAC with both intravenous and inhalational levosimendan. SVR was significantly decreased with intravenous levosimendan, but no significant decrease in SVR was observed with inhalational levosimendan.Conclusions:Inhaled levosimendan is a selective pulmonary vasodilator. It causes decrease in PAP and improvement in RV function, without having a significant effect on SVR.

show abstract