800 Efficacy, tolerability and safety of levosimendan in clinical practice

Pollesello

Expert Review of Cardiovascular Therapy

2016

The later stages of heart failure are characterized by a steady decline in quality of life. Clinical priorities should be to maintain functional capacity and quality of life. In the absence of sufficient organs for transplantation, options include left ventricular assist devices and inotropic support. Areas covered: We examined data published in the last two decades on the use of inotropes and inodilators in advanced heart failure. Expert commentary: In the literature, use of conventional inotropes, including adrenergic agonists and phosphodiesterase inhibitors, appears to be suboptimal for achieving the clinical priorities of late-stage heart failure. Evidence suggests instead that the calcium-sensitizing inodilator levosimendan, administered intermittently, delivers improvements in functional capacity and quality of life and does so with no adverse impact on life expectancy. At a terminal or near-terminal stage of heart failure, the therapeutic philosophy should shift towards meeting patients' existential priorities rather than traditional heart failure-centric targets.

Section: Effect On Kidney Function In Progressing Heart Failurementioning

confidence: 97%

Advanced heart failure: an appraisal of the potential of levosimendan in this end-stage scenario and some related ethical considerations

Pollesello

Expert Review of Cardiovascular Therapy

2016

“…Apart from an overall clinical outcome benefit, renal function (defined as a decrease in serum creatinine) improved over 24 h in the levosimendan arm, as compared to the control group (−9 and −1 μM/l, respectively, p = 0,03). In parallel, the non-randomized PORTLAND study assessed the efficacy and safety of levosimendan in the treatment of acute HF in everyday clinical practice [ 26 ]. Diuresis rapidly improved in previously oliguric patients after initiation of levosimendan, along with a reduction in serum creatinine levels that persisted on day five.…”

Section: Clinical Evidencementioning

confidence: 99%

Renal Effects of Levosimendan: A Consensus Report

Yilmaz

Grossini

Silva-Cardoso

et al. 2013

Cardiovasc Drugs Ther

Renal dysfunction is common in clinical settings in which cardiac function is compromised such as heart failure, cardiac surgery or sepsis, and is associated with high morbidity and mortality. Levosimendan is a calcium sensitizer and potassium channel opener used in the treatment of acute heart failure. This review describes the effects of the inodilator levosimendan on renal function. A panel of 25 scientists and clinicians from 15 European countries (Austria, Finland, France, Hungary, Germany, Greece, Italy, Portugal, the Netherlands, Slovenia, Spain, Sweden, Turkey, the United Kingdom, and Ukraine) convened and reached a consensus on the current interpretation of the renal effects of levosimendan described both in non-clinical research and in clinical study reports. Most reports on the effect of levosimendan indicate an improvement of renal function in heart failure, sepsis and cardiac surgery settings. However, caution should be applied as study designs differed from randomized, controlled studies to uncontrolled ones. Importantly, in the largest HF study (REVIVE I and II) no significant changes in the renal function were detected. As it regards the mechanism of action, the opening of mitochondrial KATP channels by levosimendan is involved through a preconditioning effect. There is a strong rationale for randomized controlled trials seeking beneficial renal effects of levosimendan. As an example, a study is shortly to commence to assess the role of levosimendan for the prevention of acute organ dysfunction in sepsis (LeoPARDS).

Revista Portuguesa de Cardiologia

“…In the PORTLAND trial a 0.1 g/kg/min infusion rate proved to be clinically effective and safe with no pro-arrhythmic effects. 37 Two major concerns with the use of levosimendan are hypokalemia and hypotension. The mechanism underlying hypokalemia is still unknown.…”

Section: Side-effectsmentioning

confidence: 99%

Levosimendan: The current situation and new prospects

Moreno

Tavares-Silva

Lourenço

et al. 2014

Levosimendan is a pyridazinone-dinitrile derivative with positive inotropic and vasodilatory effects that has beneficial effects on myocardial performance. In previous randomized studies levosimendan improved hemodynamics and clinical course, but its effect on prognosis is still unclear. This important issue has limited its use. Although primarily used in the management of acute heart failure syndromes, this new inotropic agent may play a role in other clinical conditions. This review aims to summarize current knowledge on levosimendan and to present future prospects for the use of this drug.