WILL INTERMITTENT LEVOSIMENDAN ADMINISTRATION BRING BENEFITS IN ADVANCED HEART FAILURE?

Advanced heart failure (AdHF) is a clinical condition in which patients suffer from severe and persistent symptoms of heart failure. Recurrent hospitalizations are frequently inevitable for AdHF patients, and intravenous inotropic therapy has an important role during haemodynamic stabilization. Preventing AdHF-related hospitalizations can improve life expectancy of AdHF patients. Additionally, an ongoing discussion focuses on the applicability of intermittent cardiotonic drug therapy either for the extension of symptom relief, before heart transplantation or mechanical left ventricular assistance device (LVAD) administration, or as palliation for patients who cannot be considered for the above mentioned invasive procedures. Nevertheless, the preventive use of conventional inotropes is limited by their added risk of increased mortality.
Levosimendan, is an inodilator drug promoting cardiac contractility and peripheral circulation via calcium sensitization and vasodilatation. The combination of these actions results in a well-characterized haemodynamic response including enhancement of cardiac output and reductions in systemic blood pressure and pulmonary capillary wedge pressure. Repetitive/intermittent levosimendan administration in AdHF has also been motivated by the long-lasting haemodynamic effects after short-term infusions, that is thought to relate to its active metabolite (OR-1896) with a relatively long half-life.
In this presentation I wish to overview the currently available preclinical and clinical data that can guide the use of repeated infusions of levosimendan in AdHF. Collectively, the results provide a solid basis for clinical efforts in finding the optimal conditions for intermittent use of levosimendan in patients with AdHF.