Evidence and Current Use of Levosimendan in the Treatment of Heart Failure: Filling the Gap

Abstract

Levosimendan is a distinctive inodilator combing calcium sensitization, phosphodiesterase inhibition and vasodilating properties through the opening of adenosine triphosphate-dependent potassium channels. It was first approved in Sweden in 2000 for the short-term treatment of acutely decompensated severe chronic heart failure when conventional therapy is not sufficient, and in cases where inotropic support is considered appropriate. After more than 20 years, clinical applications have considerably expanded across critical care and emergency medicine, and levosimendan is now under investigation in different cardiac settings (eg, septic shock, pulmonary hypertension) and for non-cardiac applications (eg, amyotrophic lateral sclerosis). This narrative review outlines key milestones in levosimendan history, by addressing regulatory issues, pharmacological peculiarities and clinical aspects (efficacy and safety) of a drug that did not receive great attention in the heart failure guidelines. A brief outlook to the ongoing clinical trials is also offered.

Keywords:

• levosimendan
• heart failure
• cardiogenic shock
• cardiac surgery
• amyotrophic lateral sclerosis

Acknowledgments

Authors at the University of Bologna are supported by institutional research funds (Ricerca Fondamentale Orientata). No sources of funding were received for the preparation of this article.

Disclosure

Professor Emanuel Raschi reports personal fees from Novartis for Consultancy, outside the submitted work. Prof. Dr. Luciano Potena reports personal fees from Novartis, personal fees from Biotest, personal fees from AstraZeneca, personal fees from Abbott, personal fees from Sandoz, outside the submitted work. The author reports no other conflicts of interest relevant to this work.