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Signa vitae : journal for intesive care and emergency medicine, Vol. 3 No. Suppl. 1, 2008.

Review article

Levosimendan in acute heart failure

INO HUSEDZINOVIC ; Department for anesthesiology, resuscitation and intensive care medicine, University Hospital Dubrava, Gojko Susak Avenue No 6, 10000 Zagreb, Croatia
RUDI MILANOVIC ; Department of Surgery, University Hospital Dubrava, Gojko Susak Avenue No 6, 10000 Zagreb, Croatia
SANJA HUSEDZINOVIC ; Department for anesthesiology, resuscitation and intensive care medicine, University Hospital Dubrava, Gojko Susak Avenue No 6, 10000 Zagreb, Croatia

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Abstract

Numerous adverse effects and an increased mortality are the reasons why many clinicians are often unsuccessful with the inotropic agents presently in use. New therapeutic agents have been developed in the last few years to assist the clinician in the stabilization, support and treatment of cardiovascular disease.One of the newest groups of inotropic agents is a group of agents, which increase the affinity of myofibrils for calcium and are called calcium sensitizers. Calcium sensitizers are the newest heterogeneous group of inotropic agents. The best known representatives of this group are levosimendan and pimobendan. Positive inotropic effects of levosimendan are achieved by its binding to troponin C and calcium, thereby stabilizing the tropomyosin molecule and prolonging the duration of actinmyosin overlap without a change in the net concentration of intracellular calcium. The vasodilatory effect of levosimendan is reached through activation of ATP-dependent potassium channels. This leads to a decrease in both afterload and preload, increased coronary blood flow and a resultant anti-ischemic effect. Levosimendan is therefore categorized as an antiischemic inotropic agent. Furthermore, experiments have confirmed that levosimendan as an opener of KATP - channels in the mitochondria and the sarcolemma of myocites may have an effect on the myocardium preconditioning.

Keywords

levosimendan; inotropic state; preconditioning; low cardiac output syndrome

Hrčak ID:

20354

URI

https://hrcak.srce.hr/20354

Publication date:

1.2.2008.

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