Role of Levosimendan in intensive care treatment of myocardial insufficiency

• Published in: Der Anaesthesist Vol. 56; no. 1; p. 30
• Main Authors: Rehberg, S, Ertmer, C, Van Aken, H, Lange, M, Bröking, K, Morelli, A, Westphal, M
• Format: Journal Article
• Language: German
• Published: Germany 01-01-2007
• Subjects: Calcium - physiology; Cardiac Output, Low - drug therapy; Cardiac Output, Low - physiopathology; Cardiotonic Agents - adverse effects; Cardiotonic Agents - pharmacokinetics; Cardiotonic Agents - pharmacology; Cardiotonic Agents - therapeutic use; Critical Care; Humans; Hydrazones - adverse effects; Hydrazones - pharmacokinetics; Hydrazones - pharmacology; Hydrazones - therapeutic use; Myocardial Ischemia - drug therapy; Myocardial Ischemia - physiopathology; Postoperative Care; Pyridazines - adverse effects; Pyridazines - pharmacokinetics; Pyridazines - pharmacology; Pyridazines - therapeutic use
• ISSN: 0003-2417
• DOI: 10.1007/s00101-006-1108-2

Levosimendan is a calcium sensitizer that is currently in the focus of intensive care medicine because it may be superior to standard inotropic agents in the treatment of acute myocardial insufficiency. The effects of levosimendan mainly depend on three predominant mechanisms: 1) positive inotropic effect by increasing the sensitivity of cardiac myofilaments to calcium ions, 2) vasodilatory effect by stimulation of adenosine triphosphate-sensitive potassium channels and 3) inhibition of phosphodiesterase-III. In a large number of experimental and clinical studies further possible indications for levosimendan have been described, e.g. cardioprotection during ischemia, cardiogenic shock, septic myocardial insufficiency and pulmonary hypertension. This review article critically summarizes the current scientific and clinical knowledge about levosimendan, its pharmacologic characteristics, mechanisms of action as well as indications and potential risks.