An emerging role for calcium sensitisation in the treatment of heart failure

Abstract

Heart failure occurs in 2 – 3% of the adult population in the developed world. With decompensation of cardiac function, haemodynamic stability can be achieved by using intravenous vasodilators, diuretics and inotropes. Unlike traditional inotropes, Ca2+ sensitisers enhance cardiac function without significantly increasing cardiac oxygen consumption, promoting arrhythmia or impairing lusitropy. The most promising drug in this new class is levosimendan, which has a unique dual mechanism; it enhances cardiac output through a Ca²⁺-dependent stabilisation of cardiac myofilaments and exhibits vasodilatory effects by opening ATP-dependent K⁺ channels. Clinical trials have demonstrated the beneficial haemodynamic effects of levosimendan, and prospective trials are currently underway to confirm its potential benefits on long-term prognosis. Updated guidelines from the European Society of Cardiology advise on how to incorporate levosimendan into care for patients who have acute heart failure.

Keywords::

• calcium sensitiser
• clinical trials
• heart failure
• heart-failure therapy
• inotropes
• levosimendan