Grieshaber P et al. (University Hospital Giessen, Germany) J Cardiothorac Surg 2016; 11: 162-172. RETROSPECTIVE CLINICAL STUDY.
The results are based on data from a single centre, where the medical records of 288 patients with preoperative LVEF ≤35% undergoing cardiopulmonary bypass surgery were analysed. After propensity matching, 84 patients receiving prophylactic levosimendan at the induction of anaesthesia were included, and matched with 164 patients who did not receive levosimendan. Follow-up for 3 years showed no difference in survival between the groups, although 30-day mortality rate was non-significantly lower with levosimendan (16 vs. 21%, p=0.37). Multivariate regression analysis revealed that acute kidney injury occurred significantly less frequently with levosimendan compared to control (coefficient -1.37; p<0.001). A higher rate of atrial fibrillation within 24h of surgery was observed in the levosimendan group (OR 4.0; 95% CI 2.2–7.2; p<0.0001).
Fuchs C, et al. Best Pract Res Clin Anaesthesiol 2016;30:479-89. REVIEW ARTICLE.
Agents which combine vasodilation with positive inotropy may be promising in patients with microcirculatory disorders. The present article reviews the effects of different vasodilators and inodilators (e.g. levosimendan) on macro- and microcirculation in the treatment of shock and microvascular dysfunction. There are presently no hard data to recommend any vasodilator for routine practice. Two smaller clinical studies with levosimendan and a meta-analysis reported beneficial results, but the results of the recent LeoPARDS study were not encouraging for a widespread use, implying the need for careful selection of septic patients who are treated with inodilators.
Yaman A, et al. Cardiol J 2016;23:610-5. RETROSPECTIVE CLINICAL TRIAL.
Case reports and case series have indicated that levosimendan may be beneficial in the treatment of Takotsubo cardiomyopathy (left ventricular apical ballooning syndrome). The present article is to the best of our knowledge the first to publish a comparative study with or without levosimendan added to standard therapy, albeit in a fairly small population (n=42). The increase in left ventricular ejection fraction was similar in both treatment groups. However, the time to an increase in left ventricular ejection fraction to above 50% (8.3 vs 10.8 days) and the length of hospital stay (9.4 vs 14.3 days) were significantly shorter with levosimendan, compared to standard therapy.
Tarvasmäki T, et al. Critical Care 2016;20:208-18. PROSPECTIVE OBSERVATIONAL STUDY.
The article evaluates vasopressors and inotropes and the combination of these drugs in the treatment of cardiogenic shock in 216 patients in the multinational CardShock study. In a multivariable regression model levosimendan was used in 24% of the cases and dobutamine in 49%. Adrenaline was associated with increased 90-day mortality and worsened cardiac and renal biomarkers. Levosimendan or dobutamine in combination with noradrenaline was associated with a more positive outcome.
Kivikko M et al. Int J Cardiol 2016;215:26-31. POST-HOC ANALYSIS OF RANDOMISED CONTROLLED TRIAL.
No overall statistically significant difference in 180-day mortality was seen in the SURVIVE trial comparing levosimendan and dobutamine in acute heart failure patients, although mortality in the Finnish population of the study was significantly lower in the levosimendan group compared to the dobutamine group. The lower mortality in the Finnish patients treated with levosimendan was associated with higher use of β-blockers, higher frequency of myocardial infarction at admission, and shorter delay between randomisation and start of treatment.
Nieminen MS, et al. Int J Cardiol 2016;218:150-7. EXPERT CONSENSUS.
Acute heart failure and/or cardiogenic shock are frequently triggered by ischaemic coronary events. The inodilator levosimendan offers potential benefits due to a range of distinct effects including positive inotropy, restoration of ventriculo-arterial coupling, increases in tissue perfusion, and anti-stunning and anti-inflammatory effects.
Farmakis D, et al. Int J Cardiol 2016;222:303-12. REVIEW ARTICLE AND CONSENSUS PAPER.
Levosimendan has been shown to have several pleiotropic effects in addition to positive inotropy and vasodilation, as anti-inflammatory, anti-oxidative and anti-apoptotic effects. Levosimendan is expected to have favourable effects in other conditions associated with acute heart failure, including cardiac surgery, acute coronary syndromes, right ventricular failure and cardiogenic shock.
Sangalli F, et al. J Cardiothorac Vasc Anesth 2016 [ePub].
In patients with cardiogenic shock already supported with extracorporeal membrane oxygenation, levosimendan improved endothelial function and haemodynamics and facilitated weaning from the extracorporeal support. However, the very small number of patients and lack of a control group hamper the interpretation of the results.
Mansiroglu A, et al. Acta Cardiol 2016;71:411-15. RANDOMISED CLINICAL TRIAL.
The results of this uncontrolled study, using conventional and tissue Doppler imaging echocardiographic methods, showed that levosimendan improved right ventricular function (both systolic and diastolic) for at least 5 days. A control group was not used in this study, which makes the results weaker.
Bauersachs J, et al. Eur J Heart Fail 2016;18:1096–105.
Levosimendan is mentioned in these European guidelines on peripartum cardiomyopathy. It is stated that in the case of cardiogenic shock, one must consider levosimendan (0.1 μg/kg/min for 24 h) instead of catecholamines as first-line inotropic drug.
Based on published data on five selected drugs, the authors suggest that levosimendan, atrial natriuretic peptide (ANP) and dexmedetomidine are likely to be beneficial in reducing acute kidney injury in patients after cardiac surgery.
Molina G, et al. J Med Diagn Meth 2016;5:227-34. REVIEW ARTICLE.
The article describes the cardioprotective, anti-ischaemic, anti-inflammatory and anti-apoptotic effects of levosimendan. It also mentions that levosimendan has been shown to have protective effects against hypoxia-induced damage. Some data on levosimendan treatment in heart failure, cardiac surgery and right ventricular dysfunction are also briefly mentioned.
Fruhwald S, et al. Expert Rev Cardiovasc Ther 2016;14:1335-47.
In the literature, use of conventional inotropes, including adrenergic agonists and phosphodiesterase inhibitors, appears to be suboptimal for achieving the clinical priorities of late-stage heart failure. Evidence suggests instead that the calcium-sensitising inodilator levosimendan, administered intermittently, delivers improvements in functional capacity and quality of life and does so with no adverse impact on life expectancy.