Levosimendan in current treatment of severe heart failure

Acute heart failure is one of the most common causes of hospitalisation and patients with this disease have a high risk of rehospitalisation

or death. Drugs are being sought that would reverse this condition. Positive inotropic agents in patients with severe acute heart

failure aid in overcoming the most critical period of haemodynamic instability and bring symptomatic relief. Despite unquestionable

immediate clinical benefit, however, the majority of positive inotropic agents do not improve and even worsen the long-term prognosis

of patients, particularly of those with ischaemic heart disease. In comparison with the older inotropes, levosimendan, a calcium sensitiser,

increases myocardial contractility without increasing oxygen consumption. It has a minor proarrhythmogenic effect and provides the

advantage of a possible combination with beta blockers. Simultaneously, it causes vasodilatation of arteries and veins, including the

coronary vascular bed, which can be of significance particularly in myocardial ischaemia. In meta-analyses of clinical trials, levosimendan

has proved its efficacy in cardiac surgical perioperative care. It improves haemodynamics, reduces the extent of myocardial damage,

and, last but not least, decreases perioperative mortality. In patients with acute decompensation of chronic heart failure, the positive

effect of levosimendan on long-term survival is not so evident. In spite of certain controversies, levosimendan represents an effective

tool for overcoming a critical state in selected conditions.

Keywords: levosimendan, dobutamine, heart failure, positive inotropic agents