1088-125 Levosimendan is safe and effective in patients with severe low cardiac output heart failure and critical hypotension

Franco, Fátima; Monteiro, Pedro; Correia, Joana; Roque, Carla; Gonçalves, Francisco; Castro, Graça; Gonçalves, Lino; Freitas, Mário; Providência, Luí­s A.

doi:10.1016/s0735-1097(04)90812-1

Cited by 6 publications

(4 citation statements)

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“…In view of its vasodilatory and potential blood pressure lowering effects, levosimendan alone was not a drug of first choice in cardiogenic shock. There are, however, several recent clinical observations indicating that levosimendan can improve haemodynamics even in patients with cardiogenic shock if it is combined with catecholamines to maintain adequate perfusion pressures [75][76][77][78][79] (Table 2).…”

Section: Cardiogenic Shockmentioning

confidence: 99%

Evidence-based use of levosimendan in different clinical settings

Luca

Colucci

Nieminen

et al. 2006

European Heart Journal

162

102

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Levosimendan is a new calcium sensitizer and K-ATP channel opener. Compared with other inodilators, it improves myocardial contractility without increasing oxygen requirements and induces peripheral and coronary vasodilation with a potential anti-stunning, anti-ischaemic effect. The documentation regarding levosimendan is one of the largest ever on the safety and efficacy of a new pharmacological agent in acute heart failure syndromes. Recent experiences in small-scale studies and randomized clinical trials have led to greater interest in the use of this drug for the support of impaired cardiac function also in patients with ischaemic heart disease and cardiogenic or septic shock. It is also demonstrated that this drug could be used as bridge therapy for the peri-operative phase of cardiac surgery in both adult and paediatric populations. This review summarizes the evidence from published scientific literature regarding the use of levosimendan in various clinical settings.

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Section: Cardiogenic Shockmentioning

confidence: 99%

Evidence-based use of levosimendan in different clinical settings

Luca

Colucci

Nieminen

et al. 2006

European Heart Journal

162

102

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“…Franco and coworkers 14 showed that early addition of levosimendan to conventional inotropic therapy (dobutamine and/or dopamine) in patients with severe hypotension and progressive cardiogenic shock improved hemodynamic status and clinical outcomes. Patients who received levosimendan therapy (group 1, n ϭ 15) required conventional inotrope support for half as long as those who were not given levosimendan (group 2, n ϭ 11): 62 Ϯ 38 hours for group 1 compared with 120 Ϯ 48 hours for group 2, p Ͻ0.05.…”

Section: Therapeutic Efficacy Of Levosimendan In Acute Heart Failure mentioning

confidence: 99%

European Experience on the Practical Use of Levosimendan in Patients with Acute Heart Failure Syndromes

Folláth

Franco

Silva-Cardoso

2005

The American Journal of Cardiology

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The novel calcium sensitizer and ATP-dependent potassium channel opener levosimendan has been introduced for routine use in several European countries. Recent reports on clinical experience confirm the positive hemodynamic results and beneficial clinical effects described in the initial dose-finding and randomized comparative therapeutic trials in patients with severe low-output heart failure. In addition, studies in small series of patients with cardiogenic shock after myocardial infarction and/or surgical interventions and postinterventional myocardial dysfunction ( Levosimendan is a new calcium-sensitizing drug that opens adenosine triphosphate-dependent potassium (K ATP ) channels with effects that increase myocardial contraction and cause vasodilation. Compared with other agents for acute heart failure syndromes (AHFS), its main potential advantages are the improvement of myocardial contractility without increasing oxygen requirements, reduction of ventricular preload, and an antistunning, anti-ischemic effect by opening K ATP channels. [1][2][3] This pharmacologic profile of levosimendan offers new therapeutic possibilities in patients with AHFS. In initial dose-finding 4,5 and therapeutic trials, 6 a rapid and prolonged hemodynamic improvement with an increase in cardiac index, reduction of pulmonary capillary wedge pressure (PCWP), and reduction of peripheral vascular resistance without proarrhythmic effects were documented. Furthermore, positive effects on long-term survival up to 6 months were observed. 6,7 Levosimendan is registered for clinical use in several countries in Europe, South America, and Asia. There are an increasing number of reports on practical experiences and therapeutic successes in different clinical situations. In this article, we summarize recent publications on therapeutic indications, dose schedules, outcomes, and tolerance. MethodsClinical reports on levosimendan therapy in patients with severe decompensated acute or chronic heart failure (HF), cardiogenic shock after myocardial infarction (MI), or cardiac interventions and perioperative administration are reviewed. These publications were mostly smaller randomized or observational trials, with good descriptions of patient inclusion criteria, levosimendan administration, and methods of clinical and/or hemodynamic evaluation. Therapeutic Efficacy of Levosimendan in Acute Heart Failure SyndromesDecompensated low-output heart failure: Decompensated low-output HF is the best documented therapeutic indication for levosimendan administered as a single intravenous infusion lasting 6 to 24 hours. Patients included in the dose-finding and comparative clinical trials 4 -6 were characterized by dyspnea (New York Heart Association [NYHA] functional class III to IV) and signs of venous and pulmonary congestion accompanied by peripheral vasoconstriction. Hemodynamic inclusion criteria were reduced cardiac index (Ͻ2.5 L/min per m 2 ) and increased PCWP (Ͼ16 mm Hg). Patients with systolic blood pressure Ͻ90 mm Hg were excluded in these initial ...

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“…There are several clinical observations indicating that levosimendan can improve hemodynamics even in patients with cardiogenic shock (CS) if it is combined with catecholamines to maintain adequate perfusion pressures (41,42). Samimi-Fard et al (43) investigated the effect on long-term survival of levosimendan compared to dobutamine treatment in patients with ST elevation myocardial infarction revascularized by primary coronary angioplasty who subsequently developed cardiogenic shock.…”

Section: Cardiogenic and Septic Shockmentioning

confidence: 99%