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The role of levosimendan in acute heart failure complicating acute coronary syndrome: A review and expert consensus opinion
MS. Nieminen, M. Buerke, A. Cohen-Solál, S. Costa, I. Édes, A. Erlikh, F. Franco, C. Gibson, V. Gorjup, F. Guarracino, F. Gustafsson, VP. Harjola, T. Husebye, K. Karason, I. Katsytadze, S. Kaul, M. Kivikko, G. Marenzi, J. Masip, S....
Language English Country Netherlands
Document type Consensus Development Conference, Journal Article, Review
- MeSH
- Acute Coronary Syndrome complications drug therapy MeSH
- Anti-Arrhythmia Agents therapeutic use MeSH
- Hydrazones therapeutic use MeSH
- Humans MeSH
- Prognosis MeSH
- Pyridazines therapeutic use MeSH
- Practice Guidelines as Topic MeSH
- Heart Failure drug therapy etiology MeSH
- Drug Synergism MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Consensus Development Conference MeSH
- Review MeSH
Acute heart failure and/or cardiogenic shock are frequently triggered by ischemic coronary events. Yet, there is a paucity of randomized data on the management of patients with heart failure complicating acute coronary syndrome, as acute coronary syndrome and cardiogenic shock have frequently been defined as exclusion criteria in trials and registries. As a consequence, guideline recommendations are mostly driven by observational studies, even though these patients have a particularly poor prognosis compared to heart failure patients without signs of coronary artery disease. In acute heart failure, and especially in cardiogenic shock related to ischemic conditions, vasopressors and inotropes are used. However, both pathophysiological considerations and available clinical data suggest that these treatments may have disadvantageous effects. 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. In clinical trials levosimendan improves symptoms, cardiac function, hemodynamics, and end-organ function. Adverse effects are generally less common than with other inotropic and vasoactive therapies, with the notable exception of hypotension. The decision to use levosimendan, in terms of timing and dosing, is influenced by the presence of pulmonary congestion, and blood pressure measurements. Levosimendan should be preferred over adrenergic inotropes as a first line therapy for all ACS-AHF patients who are under beta-blockade and/or when urinary output is insufficient after diuretics. Levosimendan can be used alone or in combination with other inotropic or vasopressor agents, but requires monitoring due to the risk of hypotension.
Cardiological Intensive Care Unit Alexandrovski Central Clinical Hospital Kiev Ukraine
Cardiological Intensive Care Unit Cardiological Center Monzino Milan Italy
Critical Care Proprietary Products Orion Pharma Espoo Finland
Department of Anesthesiology University Hospitals Leuven Leuven Belgium
Department of Cardiology 2 Niguarda Ca' Granda Hospital Milan Italy
Department of Cardiology Alexandra General Hospital of Athens Athens Greece
Department of Cardiology Coimbra Hospital and University Centre Coimbra Portugal
Department of Cardiology Lariboisière Hospital Paris France
Department of Cardiology North Estonia Medical Center Tallinn Estonia
Department of Cardiology Odense University Hospital Denmark
Department of Cardiology Oslo University Hospital Oslo Norway
Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
Department of Cardiology University Clinic Lomonosov Moscow State University Moscow Russia
Department of Cardiology University Hospital Virgen Macarena Seville Spain
Department of Cardiology University of Debrecen Debrecen Hungary
Department of Cardiothoracic Anesthesia and Intensive Care University Hospital of Pisa Pisa Italy
Department of Emergency Medicine and Services Helsinki University Hospital Helsinki Finland
Department of Intensive Internal Medicine University Medical Center Ljubljana Ljubljana Slovenia
Department of Internal Medicine 2 St Marien Hospital Siegen Siegen Germany
Department of Internal Medicine 4 Hietzing Hospital Vienna Austria
Heart and Vascular Center Semmelweis University Budapest Hungary
Heart Center Rigshospitalet Copenhagen Denmark
Helsinki University Central Hospital Helsinki Finland
Royal Devon and Exeter NHS Foundation Trust Exeter UK
University of Dresden Heart Center Dresden University Hospital Dresden Germany
References provided by Crossref.org
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- $a Nieminen, Markku S $u Helsinki University Central Hospital, Helsinki, Finland. Electronic address: markku.nieminen@hus.fi.
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- $a The role of levosimendan in acute heart failure complicating acute coronary syndrome: A review and expert consensus opinion / $c MS. Nieminen, M. Buerke, A. Cohen-Solál, S. Costa, I. Édes, A. Erlikh, F. Franco, C. Gibson, V. Gorjup, F. Guarracino, F. Gustafsson, VP. Harjola, T. Husebye, K. Karason, I. Katsytadze, S. Kaul, M. Kivikko, G. Marenzi, J. Masip, S. Matskeplishvili, A. Mebazaa, JE. Møller, J. Nessler, B. Nessler, A. Ntalianis, F. Oliva, E. Pichler-Cetin, P. Põder, A. Recio-Mayoral, S. Rex, R. Rokyta, RH. Strasser, E. Zima, P. Pollesello,
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