Document Detail

Considerations on the efficacy and safety of levosimendan in ischemic heart failure.
MedLine Citation:
PMID:  14635369     Owner:  NLM     Status:  MEDLINE    
Levosimendan is a new vasodilator agent with properties which improve cardiac contractility by calcium sensitization. Its dose-related efficacy and prolonged action have been documented in several major studies both against placebo and dobutamine. Out of 997 patients, 837 (84%) had acute or stable heart failure due to coronary heart disease. Therefore, it would be most interesting to analyze the efficacy and safety of levosimendan in heart failure due to ischemic heart disease. The dose-finding study included 98 patients who were given intravenous levosimendan at different doses and 20 patients treated with dobutamine. All patients had heart failure due to coronary heart disease. The other major trial included 500 acute myocardial infarction patients with heart failure and was placebo-controlled. In other levosimendan vs placebo or dobutamine comparative trials 50-60% of patients had ischemic heart disease and severe heart failure. Levosimendan significantly improves the cardiac index by 30-39% at bolus doses of 6-24 micrograms/kg/min followed by infusion doses of 0.05-0.2 microgram/kg/min and reduces the wedge pressure by 20-25% to optimal levels (from 15-20 mmHg). There is a lesser blood pressure reduction and some heart rate increase. However in patients with an acute myocardial infarction the rate of ischemia or hypotension were similar in levosimendan- and placebo-treated patients and in the dobutamine controlled trials no major adverse effects were seen or they were more frequent in dobutamine patients. There is no increase in mortality either compared to placebo or to dobutamine. Rather, the opposite seems to be true. No increase in arrhythmias is seen. The hemodynamic effects of levosimendan are dose-dependent and the current recommended doses are safe. No increase in mortality or any life-threatening arrhythmias have been observed.
Markku S Nieminen; Esa-Pekka Sandell
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Italian heart journal : official journal of the Italian Federation of Cardiology     Volume:  4 Suppl 2     ISSN:  1129-471X     ISO Abbreviation:  Ital Heart J     Publication Date:  2003 May 
Date Detail:
Created Date:  2003-11-25     Completed Date:  2004-03-26     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  100909716     Medline TA:  Ital Heart J     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  39S-44S     Citation Subset:  IM    
Division of Cardiology, University Central Hospital, 00290 Helsinki, Finland.
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MeSH Terms
Calcium Channels, L-Type / therapeutic use*
European Union
Heart Failure / drug therapy*,  physiopathology
Hydrazones / therapeutic use*
Myocardial Contraction / drug effects
Myocardial Ischemia / drug therapy*,  physiopathology
Pyridazines / therapeutic use*
Treatment Outcome
United States / epidemiology
Vasodilator Agents / therapeutic use*
Reg. No./Substance:
0/Calcium Channels, L-Type; 0/Hydrazones; 0/Pyridazines; 0/Vasodilator Agents; 131741-08-7/simendan

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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