In the present review striking data showing that intensive care unit patients with acute
heart failure and high-risk surgical patients may markedly benefit from the use of
levosimendan are presented. Indeed,
levosimendan is an effective new agent that acts via two complementary mechanisms. It enhances cardiac contractility by improving the response of the myofilaments to intracellular
calcium, and it reduces the cardiac workload by opening the
adenosine triphosphate-dependent
potassium channels for the dilation of blood vessels. Because the therapeutic levels of
levosimendan do not increase the intracellular
calcium concentrations,
levosimendan is less likely than traditional inotropes (beta-agonist inotropes or
phosphodiesterase inhibitors) to elicit arrhythmias or impair diastolic relaxation. In fact, the results of recent clinical studies indicate that
levosimendan offers significant hemodynamic and survival benefits when given to patients who are hospitalized for acute
heart failure. Indeed, in the near future, it is likely that
levosimendan may also prove effective for the treatment of patients with
diastolic heart failure or for those with a
low cardiac output following
coronary artery bypass grafting. In addition,
levosimendan has the potential of supporting the cardiac function during the initiation of beta-blocker
therapy, for weaning patients from
cardiopulmonary bypass, for individuals with valvular abnormalities and for those with
myocarditis. Preliminary results also suggest that
levosimendan may be beneficial for the treatment of patients with right ventricular
heart failure. Although the use of
levosimendan has been fully validated for the most common causes of acute
heart failure, additional clinical trials are needed to safety broaden its therapeutic indications.