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Journal of Cardiovascular Pharmacology and Therapeutics
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Levosimendan and Calcium Sensitization of the Contractile Proteins in Cardiac Muscle: Impact on Heart Failure

Bindu Kota, MD

West LA VA Medical Center

Aditya S. Prasad, MD

Cedars-Sinai Medical Center Los Angeles, California

Christina Economides, MD

West LA VA Medical Center

Bramah N. Singh, MD, DSc

West LA VA Medical Center, Division of Cardiology, David Geffen School of Medicine, UCLA bsingh{at}ucla.edu,

Levosimendan increases the sensitivity of the cardiac fibrils to calcium, favorably affects hemodynamics in patients with heart failure. It is a positive inotrope and a peripheral vasodilator. The elimination half-life of the compound is about 1 hour. The drug decreases pulmonary capillary wedge pressure, increases cardiac output with the improvement in left ventricular ejection fraction leading to symptomatic improvement which includes decreased dyspnea and fatigue. Levosimendan can be used safely with diuretics, nitrates, beta-blockers, digoxin, and angiotensin-converting enzyme inhibitors. The most common adverse effects of levosimendan are headache and hypotension. Prolongation of the QTc interval does not appear to increase the incidence of arrhythmias, including ventricular tachycardia, ventricular fibrillation, and torsades de pointes. Levosimendan is a novel agent in the treatment of decompensated heart failure, representing a newer class of medications aimed at increasing calcium sensitivity. Its properties holds promise for the treatment of heart failure but further large-scale studies will be needed to determine its precise efficacy, safety, as well as the compound's long-term impact on mortality.

Key Words: levosimendan • calcium sensitivity • inotrope • QTc • heart failure • diuretics

Journal of Cardiovascular Pharmacology and Therapeutics, Vol. 13, No. 4, 269-278 (2008)
DOI: 10.1177/1074248408324550


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