DOI: http://dx.doi.org/10.18203/2349-3933.ijam20203129

Levosimendan: a remedy for treating the patients of decompensated heart failure

Vikramjit Singh Dhaliwal, Manpreet Singh Gill, Monika .

Abstract


Background: Levosimendan is a new-fangled calcium based sensitizer which is used to treat the patients with congestive or decompensated heart failure. The empirical study reveals that it intensifies myocardial contractility and expands coronary and peripheral vessels without affecting the diastolic function adversely. Levosimendan also performs as an opener of ATP-based K channels in vascular smooth muscle. The empirical research study shows the benefits of usage of levosimendan over other drugs in the treatment of decompensated and congestive heart failure.

Methods: Levosimendan has been administered to patients with decompensated heart failure conditions. Infusion of levosimendan started with a dose of 0.1 µg/kg/min and titrated to 0.2 µg/kg/min. The systolic BP has been monitored after the administration of levosimendan to maintain stability in the patient’s BP for the initial 2-3 hours. The suggested duration of infusion of levosimendan in critical heart failure is twenty-four hours. Initially levosimendan is infused in the patients with systolic BP is more than hundred mmHg and diastolic BP is more than sixty mmHg.

Results: The outcomes of the usage of Levosimendan have been studied on 80 patients with decompensated heart problems and the comparative study has also been made with other inotropes, respectively. We have also performed a trial on two groups of people named as LIVO and NON-LIVO groups. The research study proves that the usage of levosimendan is better than other inotropes. Levosimendan can be recommended in the standard treatment of patients with acute heart conditions.

Conclusions: Levosimendan is offering an effective remedy to treat the patients with decompensated heart failure. In comparison to other inotropes available for the treatment of patients suffering from congestive heart ailments, levosimendan can be considered to be a safe and efficient sensitizer.


Keywords


Calcium based sensitizer, Decompensated heart failure, Inotropes, Levosimendan

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References


Cotter G, Metra M, Davison BA, Senger S, Bourge RC, Cleland JG, et al. VERITAS Investigators. Worsening heart failure, a critical event during hospital admission for acute heart failure: results from the VERITAS study. Euro J Heart Fail. 2014;16:1362-71.

Crespo-Leiro MG, Anker SD, Maggioni AP, Coats AJ, Filippatos G, Ruschitzka F, et al. Heart Failure Association (HFA) of the European Society of Cardiology (ESC). European Society of Cardiology Heart Failure Long-Term Registry (ESC-HF-LT): 1-year follow-up outcomes and differences across regions. Eur J Heart Fail. 2016 Jun;18(6):613-25.

Jia Z, Guo M, Zhang YQ, Liang HQ, Zhang LY, Song Y. Efficacy of intravenous levosimendan in patients with heart failure complicated by acute myocardial infarction. Cardiol. 2014;128(2):195-201.

Pollesello P, Parissis J, Kivikko M, Harjola VP. Levosimendan meta-analyses: is there a pattern in the effect on mortality? Int J Cardiol. 2016;209:77-83.

Belletti A, Castro ML, Silvetti S, Greco T, Biondi-Zoccai G, Pasin L, et al. The Effect of inotropes and vasopressors on mortality: a meta-analysis of randomized clinical trials. Br J Anaesth. 2015;115(5):656-75.

Gruhn N, Nielsen-Kudsk JE, Theilgaard S, Bang L, Olesen SP, Aldershvile J. Coronary vasorelaxant effect of levosimendan, a new inodilator with calcium-sensitizing properties. J Cardiovasc Pharmacol. 1998;31(5):741-9.

Mushtaq S, Andreini D, Farina S, Salvioni E, Pontone G, Sciomer S, et al. Levosimendan improves exercise performance in patients with advanced chronic heart failure. ESC heart failure. 2015 Sep;2(3):133-41.

Pagel PS, Harkin CP, Hettrick DA, Warltier DC. Levosimendan (OR-1259), a myofilament calcium sensitizer, enhances myocardial contractility but does not alter isovolumic relaxation in conscious and anesthetized dogs. Anesthesiology: The J Ame Soci Anesthesiologists. 1994 Oct 1;81(4):974-87.

Louhelainen M, Vahtola E, Kaheinen P, Leskinen H, Merasto S, Kytö V, et al. Effects of levosimendan on cardiac remodeling and cardiomyocyte apoptosis in hypertensive Dahl/Rapp rats. Br J Pharmacol. 2007;150(7):851-61.

Silvetti S, Belletti A, Fontana A, Pollesello P. Rehospitalization after intermittent levosimendan treatment in advanced heart failure patients: a meta-analysis of randomized trials. ESC Heart Fail. 2017;4:595-604.

Hansen MS, Andersen A, Nielsen-Kudsk JE. Levosimendan in pulmonary hypertension and right heart failure. Pulmonary circulation. 2018 Jul;8(3):2045894018790905.

Grossini E, Caimmi PP, Platini F, Molinari C, Uberti F, Cattaneo M, et al. Modulation of programmed forms of cell death by intracoronary levosimendan during regional myocardial ischemia in anesthetized pigs. Cardiovasc Drugs Ther. 2010;24(1):5-15.

Bonios MJ, Terrovitis JV, Drakos SG, Katsaros F, Pantsios C, Nanas SN, et al. Comparison of three different regimens of intermittent inotrope infusions for end stage heart failure. Int J Cardiol. 2012;159225-9.

Andreis DT, Singer M. Catecholamines for inflammatory shock: a Jekyll-and-Hyde conundrum. Intensive Care Med. 2016;42:1387-97.

Sorsa T, Heikkinen S, Abbott MB, Abusamhadneh E, Laakso T, Tilgmann C, et al. Binding of levosimendan, a calcium sensitizer, to cardiac troponin C. J Biological Chemistry. 2001 Mar 23;276(12):9337-43.

Höhn J, Pataricza J, Petri A, Tóth GK, Balogh Á, Varr A, et al. Levosimendan interacts with potassium channel blockers in human saphenous veins. Basic Clin Pharmacol Toxicol. 2004 Jun;94(6):271-3.

Kivikko M, Antila S, Eha J, Lehtonen L, Pentikainen PJ. Pharmacokinetics of levosimendan and its metabolites during and after a 24-hour continuous infusion in patients with severe heart failure. Int J Clin Pharmacol Ther. 2002;40:465-71.

Mebazaa A, Nieminen MS, Filippatos GS, Cleland JG, Salon JE, Thakkar R, et al. Levosimendan vs. dobutamine: outcomes for acute heart failure patients on beta-blockers in SURVIVE. Eur J Heart Fail. 2009;11:304-11.

Altenberger J, Gustafsson F, Harjola VP, Karason K, Kindgen-Milles D, Kivikko M, et al. Levosimendan in acute and advanced heart failure: an appraisal of the clinical database and evaluation of its therapeutic applications. J Cardiovas Pharmacol. 2018 Mar;71(3):129.

Nieminen MS, Fonseca C, Brito D, Wikström G. The potential of the inodilator levosimendan in maintaining quality of life in advanced heart failure. Eur Hear Journal, Suppl. 2017;C15-C21.

Cotter G, Metra M, Davison BA, Senger S, Bourge RC, Cleland JG, et al. VERITAS Investigators. Worsening heart failure, a critical event during hospital admission for acute heart failure: results from the VERITAS study. Euro J Heart Fail. 2014;16:1362-71.

Crespo-Leiro MG, Anker SD, Maggioni AP, Coats AJ, Filippatos G, Ruschitzka F, et al. Heart Failure Association (HFA) of the European Society of Cardiology (ESC). European Society of Cardiology Heart Failure Long-Term Registry (ESC-HF-LT): 1-year follow-up outcomes and differences across regions. Eur J Heart Fail. 2016 Jun;18(6):613-25.

Jia Z, Guo M, Zhang YQ, Liang HQ, Zhang LY, Song Y. Efficacy of intravenous levosimendan in patients with heart failure complicated by acute myocardial infarction. Cardiol. 2014;128(2):195-201.

Pollesello P, Parissis J, Kivikko M, Harjola VP. Levosimendan meta-analyses: is there a pattern in the effect on mortality? Int J Cardiol. 2016;209:77-83.

Belletti A, Castro ML, Silvetti S, Greco T, Biondi-Zoccai G, Pasin L, et al. The Effect of inotropes and vasopressors on mortality: a meta-analysis of randomized clinical trials. Br J Anaesth. 2015;115(5):656-75.

Gruhn N, Nielsen-Kudsk JE, Theilgaard S, Bang L, Olesen SP, Aldershvile J. Coronary vasorelaxant effect of levosimendan, a new inodilator with calcium-sensitizing properties. J Cardiovasc Pharmacol. 1998;31(5):741-9.

Mushtaq S, Andreini D, Farina S, Salvioni E, Pontone G, Sciomer S, et al. Levosimendan improves exercise performance in patients with advanced chronic heart failure. ESC heart failure. 2015 Sep;2(3):133-41.

Pagel PS, Harkin CP, Hettrick DA, Warltier DC. Levosimendan (OR-1259), a myofilament calcium sensitizer, enhances myocardial contractility but does not alter isovolumic relaxation in conscious and anesthetized dogs. Anesthesiology: The J Ame Soci Anesthesiologists. 1994 Oct 1;81(4):974-87.

Louhelainen M, Vahtola E, Kaheinen P, Leskinen H, Merasto S, Kytö V, et al. Effects of levosimendan on cardiac remodeling and cardiomyocyte apoptosis in hypertensive Dahl/Rapp rats. Br J Pharmacol. 2007;150(7):851-61.

Silvetti S, Belletti A, Fontana A, Pollesello P. Rehospitalization after intermittent levosimendan treatment in advanced heart failure patients: a meta-analysis of randomized trials. ESC Heart Fail. 2017;4:595-604.

Hansen MS, Andersen A, Nielsen-Kudsk JE. Levosimendan in pulmonary hypertension and right heart failure. Pulmonary circulation. 2018 Jul;8(3):2045894018790905.

Grossini E, Caimmi PP, Platini F, Molinari C, Uberti F, Cattaneo M, et al. Modulation of programmed forms of cell death by intracoronary levosimendan during regional myocardial ischemia in anesthetized pigs. Cardiovasc Drugs Ther. 2010;24(1):5-15.

Bonios MJ, Terrovitis JV, Drakos SG, Katsaros F, Pantsios C, Nanas SN, et al. Comparison of three different regimens of intermittent inotrope infusions for end stage heart failure. Int J Cardiol. 2012;159225-9.

Andreis DT, Singer M. Catecholamines for inflammatory shock: a Jekyll-and-Hyde conundrum. Intensive Care Med. 2016;42:1387-97.

Sorsa T, Heikkinen S, Abbott MB, Abusamhadneh E, Laakso T, Tilgmann C, et al. Binding of levosimendan, a calcium sensitizer, to cardiac troponin C. J Biological Chemistry. 2001 Mar 23;276(12):9337-43.

Höhn J, Pataricza J, Petri A, Tóth GK, Balogh Á, Varr A, et al. Levosimendan interacts with potassium channel blockers in human saphenous veins. Basic Clin Pharmacol Toxicol. 2004 Jun;94(6):271-3.

Kivikko M, Antila S, Eha J, Lehtonen L, Pentikainen PJ. Pharmacokinetics of levosimendan and its metabolites during and after a 24-hour continuous infusion in patients with severe heart failure. Int J Clin Pharmacol Ther. 2002;40:465-71.

Mebazaa A, Nieminen MS, Filippatos GS, Cleland JG, Salon JE, Thakkar R, et al. Levosimendan vs. dobutamine: outcomes for acute heart failure patients on beta-blockers in SURVIVE. Eur J Heart Fail. 2009;11:304-11.

Altenberger J, Gustafsson F, Harjola VP, Karason K, Kindgen-Milles D, Kivikko M, et al. Levosimendan in acute and advanced heart failure: an appraisal of the clinical database and evaluation of its therapeutic applications. J Cardiovas Pharmacol. 2018 Mar;71(3):129.

Nieminen MS, Fonseca C, Brito D, Wikström G. The potential of the inodilator levosimendan in maintaining quality of life in advanced heart failure. Eur Hear Journal, Suppl. 2017;C15-C21.