Efficacy and safety of levosimendan in patients with acute right heart failure: A meta-analysis

Qiu, Jiayong; Jia, Lei; Hao, Yingying; Huang, Shenshen; Ma, Yaqing; Li, Xiaofang; Wang, Min; Mao, Yimin

doi:10.1016/j.lfs.2017.07.001

Cited by 41 publications

(22 citation statements)

References 42 publications

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“…Levosimendan has a positive impact on several specific conditions related to GUCH surgeries. As aforementioned, GUCH patients often present with a failing RV, and a recent meta-analysis reported improved RV function when levosimendan was used to treat RV failure in a variety of heart and lung diseases [36]. Levosimendan induces vasodilatation in the pre-constricted pulmonary circulation [37], which is of particular relevance in the post-CPB setting.…”

Section: Discussionmentioning

confidence: 99%

Impact of the perioperative inotropic support in grown-up congenital heart patients undergoing cardiac surgery: a propensity score adjusted analysis

Mauriat

Bojan

Soulie

et al. 2020

Ann. Intensive Care

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Background: Grown-up congenital heart (GUCH) patients represent a growing population with a high morbidity risk when undergoing reparative surgery. A main preoperative feature is right ventricular failure, which represents a risk factor for postoperative low cardiac output syndrome. Levosimendan has a potentially beneficial effect. This retrospective study included consecutive GUCH patients with surgeries in a tertiary cardiothoracic centre between 01-01-2013 and 01-10-2017, to test the hypothesis that the postoperative use of levosimendan might be associated with shorter time of mechanical ventilation, when compared with the use of milrinone. To adjust for bias related to the probability of treatment assignment, it uses the inverse propensity score weighting methodology. Results: Overall 363 patients had GUCH surgeries during the study period, their mean age was 31.39 ± 15.31 years, 87 patients were eligible for analysis in the Levosimendan group and 117 in the Milrinone group. The propensity score used pre-and intraoperative variables and resulted in a good balance between covariates. The Levosimendan group included patients with higher preoperative risk scores, a higher prevalence of left and right ventricular failure, who required more often the addition of epinephrine, renal replacement therapy, prolonged mechanical ventilation and intensive care stay. However, after propensity score weighting, patients in the Levosimendan group had shorter durations of mechanical ventilation (average treatment effect − 37.59 h IQR [− 138.85 to − 19.13], p = 0.01) and intensive care stay (average treatment effect − 3.11 days IQR [− 10.03 to − 1.48], p = 0.009). The number of days of additional epinephrine support was shorter and the vasoactive inotropic scores lower. Conclusion: We report a beneficial effect in terms of duration of mechanical ventilation and intensive care stay, and on inotropic requirements of the use of levosimendan following GUCH surgeries. The use of levosimendan in this setting requires validation at a larger scale.

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Section: Discussionmentioning

confidence: 99%

Impact of the perioperative inotropic support in grown-up congenital heart patients undergoing cardiac surgery: a propensity score adjusted analysis

Mauriat

Bojan

Soulie

et al. 2020

Ann. Intensive Care

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“…Determinative randomized trials of levosimendan in right ventricular failure (with or without pulmonary hypertension) have yet to be conducted but a recent meta-analysis of 10 studies of levosimendan in acute right-sided HF identified statistically robust benefits over placebo, with increases in tricuspid annular plane systolic excursion and ejection fraction, plus reductions in systolic pulmonary artery pressure ( P = 0.0001) and pulmonary vascular resistance ( P = 0.003). 126 Adverse events were reported not to differ significantly between groups.…”

Section: Levosimendan In Current Usementioning

confidence: 96%

Levosimendan Efficacy and Safety: 20 Years of SIMDAX in Clinical Use

Papp

Agostoni

Álvarez

et al. 2020

Journal of Cardiovascular Pharmacology

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“…Determinative randomised trials of levosimendan in right ventricular failure (with or without pulmonary hypertension) have yet to be conducted, but a recent meta-analysis of 10 studies of levosimendan in acute right-sided HF identified statistically robust benefits over placebo, with increases in tricuspid annular plane systolic excursion and ejection fraction, plus reductions in systolic pulmonary artery pressure (p=0.0001) and pulmonary vascular resistance (p=0.003). [ 126 ] Adverse events were reported not to differ significantly between groups.…”

Section: Levosimendan In Current Usementioning

confidence: 99%

Levosimendan Efficacy and Safety: 20 years of SIMDAX in Clinical Use

Papp¹,

Agostoni²,

Álvarez³

et al. 2020

Cardiac Failure Review

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Levosimendan was first approved for clinic use in 2000, when authorisation was granted by Swedish regulatory authorities for the haemodynamic stabilisation of patients with acutely decompensated chronic heart failure. In the ensuing 20 years, this distinctive inodilator, which enhances cardiac contractility through calcium sensitisation and promotes vasodilatation through the opening of adenosine triphosphate-dependent potassium channels on vascular smooth muscle cells, has been approved in more than 60 jurisdictions, including most of the countries of the European Union and Latin America. Areas of clinical application have expanded considerably and now include cardiogenic shock, takotsubo cardiomyopathy, advanced heart failure, right ventricular failure and pulmonary hypertension, cardiac surgery, critical care and emergency medicine. Levosimendan is currently in active clinical evaluation in the US. Levosimendan in IV formulation is being used as a research tool in the exploration of a wide range of cardiac and non-cardiac disease states. A levosimendan oral form is at present under evaluation in the management of amyotrophic lateral sclerosis. To mark the 20 years since the advent of levosimendan in clinical use, 51 experts from 23 European countries (Austria, Belgium, Croatia, Cyprus, Czech Republic, Estonia, Finland, France, Germany, Greece, Hungary, Italy, the Netherlands, Norway, Poland, Portugal, Russia, Slovenia, Spain, Sweden, Switzerland, UK and Ukraine) contributed to this essay, which evaluates one of the relatively few drugs to have been successfully introduced into the acute heart failure arena in recent times and charts a possible development trajectory for the next 20 years.

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Efficacy and safety of levosimendan in patients with acute right heart failure: A meta-analysis

Cited by 41 publications

References 42 publications

Impact of the perioperative inotropic support in grown-up congenital heart patients undergoing cardiac surgery: a propensity score adjusted analysis

Impact of the perioperative inotropic support in grown-up congenital heart patients undergoing cardiac surgery: a propensity score adjusted analysis

Levosimendan Efficacy and Safety: 20 Years of SIMDAX in Clinical Use

Levosimendan Efficacy and Safety: 20 years of SIMDAX in Clinical Use

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