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Review
. 2019 Nov 29;23(1):385.
doi: 10.1186/s13054-019-2674-4.

Levosimendan in the light of the results of the recent randomized controlled trials: an expert opinion paper

Bernard Cholley  1   2   3 , Bruno Levy  4 , Jean-Luc Fellahi  5   6 , Dan Longrois  7   8 , Julien Amour  9   10 , Alexandre Ouattara  11   12   13 , Alexandre Mebazaa  8   14
Affiliations
Review

Levosimendan in the light of the results of the recent randomized controlled trials: an expert opinion paper

Bernard Cholley et al. Crit Care. .

Abstract

Despite interesting and unique pharmacological properties, levosimendan has not proven a clear superiority to placebo in the patient populations that have been enrolled in the various recent multicenter randomized controlled trials. However, the pharmacodynamic effects of levosimendan are still considered potentially very useful in a number of specific situations.Patients with decompensated heart failure requiring inotropic support and receiving beta-blockers represent the most widely accepted indication. Repeated infusions of levosimendan are increasingly used to facilitate weaning from dobutamine and avoid prolonged hospitalizations in patients with end-stage heart failure, awaiting heart transplantation or left ventricular assist device implantation. New trials are under way to confirm or refute the potential usefulness of levosimendan to facilitate weaning from veno-arterial ECMO, to treat cardiogenic shock due to left or right ventricular failure because the current evidence is mostly retrospective and requires confirmation with better-designed studies. Takotsubo syndrome may represent an ideal target for this non-adrenergic inotrope, but this statement also relies on expert opinion. There is no benefit from levosimendan in patients with septic shock. The two large trials evaluating the prophylactic administration of levosimendan (pharmacological preconditioning) in cardiac surgical patients with poor left ventricular ejection fraction could not show a significant reduction in their composite endpoints reflecting low cardiac output syndrome with respect to placebo. However, the subgroup of those who underwent isolated CABG appeared to have a reduction in mortality. A new study will be required to confirm this exploratory finding.Levosimendan remains a potentially useful inodilator agent in a number of specific situations due to its unique pharmacological properties. More studies are needed to provide a higher level of proof regarding these indications.

Keywords: Beta-blocker; Cardiogenic shock; Catecholamine; Heart failure; Levosimendan.

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Conflict of interest statement

All authors are members of an advisory board working for Orion Pharma and have received honoraria from the Company for their participation to the board and for giving invited lectures at industry symposia.

Figures

Fig. 1
Fig. 1
Potential indications for levosimendan. LCOS, low cardiac output syndrome; LVEF, left ventricular ejection fraction; CABG, coronary artery bypass graft; VA ECMO, veno-arterial extra-corporeal membrane oxygenation; LVAD, left ventricular assist device
See this image and copyright information in PMC

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