Levosimendan in the treatment of cardiogenic shock

Abstract

Patients with cardiogenic shock (CS) are currently treated with acute coronary revascularization, mechanical support (i.e., IABP), and in addition with vasopressor and inotropic support. Among medical treatment dobutamine and norepinephrine are drugs of first choice. Nowadays, intravenous levosimendan, a new calcium sensitizer and K-ATP channel opener, has emerged as an alternative option of pharmacologic inotropic support in patients with cardiogenic shock. Recent reports on levosimendan's use in cardiogenic shock demonstrated more favorable effects when compared with conventional inotropic agents. Clearly, levosimendan is able to archieve profound increase of cardiac index and cardiac power index in combination with reduced systemic and pulmonary resistance reduction compared to conventional therapy. Further, levosimendan is able to improve hemodynamic parameters more rapidly compared to intraaortic ballon counter pulsation. Similar, in patients with low cardiac output syndrome upon cardiovascular surgery, levosimendan is able to improve cardiac performance when administered prior or after cardiac surgery. In the light of cardiogenic shock, the myocardial protective effects of levosimendan might be important to reduce reperfusion injury and myocardial stunning following ischemia and reperfusion. This review summarizes the evidence from current scientific literature including our recent trials regarding the mechanism of action, efficiency and the use of levosimendan in CS patients.