Levosimendan: a review of its use in the management of acute decompensated heart failure.

摘要: UNLABELLED Levosimendan (Simdax) is a calcium-sensitising drug that stabilises the troponin molecule in cardiac muscle, thus prolonging its effects on contractile proteins, with concomitant vasodilating properties. Intravenous levosimendan (12-24 microg/kg loading dose followed by 0.1-0.2 microg/kg/min for 24 hours, adjusted response and tolerability) approved short-term treatment of acute severe decompensated heart failure. Cardiac output increased about 30% pulmonary capillary wedge pressure systemic vascular resistance decreased 17-29% patients failure receiving intravenous levosimendan. In large, well controlled trials failure, was significantly more effective than placebo or dobutamine overall haemodynamic rate (primary endpoint). Significant benefits were also seen mortality (versus dobutamine) combined risk worsening death dobutamine). Improvements key symptoms (dyspnoea fatigue) have not been consistently demonstrated. Hospitalisation costs similar dobutamine; total incremental (hospitalisation plus drug) cost per life-year saved (extrapolated to 3 years) relative estimated at Euro 3205 (year costing 2000). generally tolerated, an adverse event profile recommended dosages placebo. rate/rhythm disorders headache most common events. At higher dosages, had rates sinus tachycardia those recipients. More experienced angina pectoris/chest pain/myocardial ischaemia disorders. CONCLUSION vasodilatory inotropic effects, superior efficacy/tolerability It may be associated reduced compared both dobutamine. tolerated less potential While evidence from designed confirming improved over investigating efficacy versus other positive inotropes required, appears useful addition options low output.