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European Journal of Heart Failure 2003 5(1):13-21; doi:10.1016/S1388-9842(02)00118-6
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© 2002 European Society of Cardiology

Pharmacotherapeutic approaches for decompensated heart failure: a role for the calcium sensitiser, levosimendan?

Barry Greenberga,*, Claudio Borghib and Sergio Perronec

a Department of Medicine, University of California School of Medicine San Diego, CA, USA
b Department of Internal Medicine Policlinico S Orsola, Bologna, Italy
c Fundacion Favaloro—Sector Transplantes Buenos Aires, Argentina

* Corresponding author. Cardiology Division, University of California School of Medicine, 200 West Arbor St, San Diego, CA, 92103-8411, USA. Tel.: +1-619-543-7751; fax: +1-619-543-7870 E-mail address: bgreenberg{at}ucsd.edu


  Abstract

Although no universal definition exists, decompensated heart failure may be regarded as either a worsening of chronic heart failure or new-onset heart failure precipitated by an acute incident. Haemodynamic management of patients hospitalised with decompensated heart failure may include the administration of diuretics, vasodilators and positive inotropic agents. Until recently, these latter agents constituted the only drug class to produce a direct increase in stroke volume via enhanced myocardial contractility. However, despite their short-term benefits, the clinical utility of inotropic agents is compromised by their potentially deleterious effects on calcium handling and oxygen consumption, resulting in an increased risk of serious ventricular arrhythmias and death. In contrast, calcium sensitisers enhance cardiac performance without affecting calcium movement and, therefore, are potentially associated with a reduced risk of rhythmic disturbances. These agents constitute a heterogeneous group of compounds with different affinities for calcium sensitisation. Levosimendan is a potent calcium sensitiser with vasodilating properties that has been shown to provide symptomatic and haemodynamic improvement with no increase in oxygen consumption. Calcium sensitisation is therefore emerging as a promising treatment approach in this challenging therapeutic area.

Key Words: Levosimendan • Calcium sensitisers • Decompensated heart failure • Haemodynamics

Received June 4, 2001; Revised January 17, 2002; Accepted April 10, 2002


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