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Levosimendan in acute heart failure


1Department for anesthesiology, resuscitation and intensive care medicine University Hospital Dubrava Zagreb

DOI: 10.22514/SV31.022008.3 Vol.3,Issue S1,February 2008 pp.13-16

Published: 01 February 2008

*Corresponding Author(s): INO HUSEDZINOVIC E-mail:


Numerous adverse effects and an increased mortality are the reasons why many clinicians are often unsuccessful with the inotropic agents presently in use. New therapeutic agents have been developed in the last few years to assist the clinician in the stabilization, support and treatment of cardiovascular disease.

One of the newest groups of inotropic agents is a group of agents, which increase the affinity of myofibrils for calcium and are called calcium sensitizers. Calcium sensitizers are the newest heterogeneous group of inotropic agents. The best known representatives of this group are levosimendan and pimobendan. Positive inotropic effects of levosimendan are achieved by its binding to troponin C and calcium, thereby stabilizing the tropomyosin molecule and prolonging the duration of actin-myosin overlap without a change in the net concentration of intracellular calcium. The vasodilatory effect of levosimendan is reached through activation of ATP-dependent potassium channels. This leads to a decrease in both afterload and preload, increased coronary blood flow and a resultant anti-ischemic effect. Levosimendan is therefore categorized as an anti-ischemic inotropic agent. Furthermore, experiments have confirmed that levosimendan as an opener of KATP – channels in the mitochondria and the sarcolemma of myocites may have an effect on the myocardium preconditioning.


levosimendan, inotropic state, preconditioning, low cardiac output syndrome

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INO HUSEDZINOVIC,RUDI MILANOVIC,SANJA HUSEDZINOVIC. Levosimendan in acute heart failure. Signa Vitae. 2008. 3(S1);13-16.


1. Priebe HJ. Vasoactive drugs (IARS Review Course Lectures). Anesth Analg 2004;64:79-83.

2. Nieminen MS, Bohn M, Cowie MR, Drexler H, Filippatos GS, Jondeau G, et al, editors. Executive summary of the guidelines on the diagnosis and treatment of acute heart failure. Eur Heart J 2005;26:284-416.

3. Lehonen LA. Levosimendan: a parenteral calcium-sensitizing drug with additional vasodilatatory properties. Expert Opin Investing Drugs 2001;10:955-70.

4. Mebaza A, Erhardt L. Levosimendan: a new dual – action drug in the treatment of acute heart failure. Int J Clin Pract 2003;57:410-6.

5. Niemenn MS, Akkila J. Hemodynamic and neurohumoral effects of continuous infusion of levosimendan in patients with congestive heart failure. J Am Coll Cardiol 2000;36:1903-12.

6. Slawsky MT, Colucci WS. Acute hemodynamic and clinical effects of levosimendan in patients with severe heart failure. Circulation 2000;102:2222-7.

7. Moiseyev VS, Poder P, Andrejevs N, Ruda MY, Golikov AP, Lazebnik LB, et al, editors. Safety and efficacy of a novel calcium sensitizer, levosimendan, in patients with left ventricular failure due to an acute myocardial infarction. A randomized, placebo-controlled, double blind study (RUSSLAN). Eur Heart J 2002;23:1422-32.

8. Follath F, Cleland JG, Just H, Papp JG, Scholz H, Peuhkurinen K, et al, editors. Efficacy and safety of intravenous levosimendan compared with dobutamine in severe low-output heart failure (the LIDO study): a randomised double-blind trial. Lancet 2002;360:196-202.

9. Lilleberg J, Nieminen MS. Effects of a new calcium sensitizer, levosimendan, on hemodynamics, coronary blood flow and myocardial substrate utilization early after coronary artery bypass grafting. Eur Heart J 1998;19:660-8.

10. Barisin S, Husedzinovic I, Sonicki Z, Bradic N, Barisin A, Tonkovic D. Levosimendan in Off–Pump Coronary Artery Bypass; A Four – times Masked Controlled Study. J Cardivasc Pharmaco 2004;44:703-8.

11. Husedžinović I, Barišin S, Bradić N, Barišin A, Sonicki Z, Milanović R. Levosimendan as a new strategy during off – pump coronary artery bypass grafting: Double – blind randomized placebo – controlled trial. Croat Med J 2005;46(6):950-6.

12. Husedzinovic I, Bradic N, Barisin S. Levosimendan-hemodynamic support during off-pump coronary artery bypass graft surgery. Intensive Care Med 2005;31(suppl 1)S97.

13. Murry CE, Jennings RB. Preconditioning with ischemia: a delay of lethal cell injury in ischaemic myocardium. Circulation 1986;74:1124-36.

14. Tritapepe L, De Santis V. Preconditioning effects of levosimendan in coronary artery bypass grafting-a pilot study. BJA 2007;96:694-700.

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