Levosimendan: A Novel Inotropic Agent for Treatment of Acute, Decompensated Heart Failure

2005 ◽  
Vol 39 (11) ◽  
pp. 1888-1896 ◽  
Author(s):  
Grace L Earl ◽  
James T Fitzpatrick
Keyword(s):  
Heart Failure ◽  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Mortality Data ◽  
Pharmacokinetic Studies ◽  
Dependent Manner ◽  
Term Survival ◽  
Calcium Sensitizer

OBJECTIVE To review the literature on a novel calcium sensitizer, levosimendan. DATA SOURCES Articles were identified through searches of MEDLINE (1966–June 2005), International Pharmaceutical Abstracts (1970–June 2005), and EMBASE (1992–June 2005) using the key words levosimendan, simendan, calcium sensitizer, calcium sensitiser, and congestive heart failure. STUDY SELECTION AND DATA EXTRACTION Clinical trials and pharmacokinetic studies evaluating the safety and efficacy of levosimendan were selected. DATA SYNTHESIS Levosimendan 6–24 μg/kg intravenous bolus followed by a 24-hour continuous infusion of 0.05—0.2 μg/kg/min improved cardiac output and reduced pulmonary capillary wedge pressure in a dose-dependent manner. Dose-ranging and randomized clinical trials have demonstrated improvement in symptoms and hemodynamics and short-term survival outcomes in the treatment of acute, decompensated heart failure. Clinical trials evaluating retrospective mortality data and combined endpoints (mortality, rehospitalization) have demonstrated better outcomes with levosimendan compared with dobutamine. The incidence of hypotension with levosimendan is not significantly different than with dobutamine, but there is a dose-related increase in heart rate. CONCLUSIONS Levosimendan is useful in moderate to severe low-output heart failure in patients who have failed to respond to diuretics and vasodilators. Based on current studies, levosimendan appears to be a safe alternative to dobutamine for treatment of acute, decompensated heart failure. Prospective clinical trials are needed to confirm the effect of levosimendan on long-term survival and its role in heart failure in the setting of myocardial infarction.

Medical Therapy for Acute Decompensated Heart Failure: What Recent Clinical Trials Have Taught Us About Diuretics and Vasodilators

2011 ◽  
Vol 9 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Catherine Marti ◽  
Robert Cole ◽  
Andreas Kalogeropoulos ◽  
Vasiliki Georgiopoulou ◽  
Javed Butler
Keyword(s):  
Heart Failure ◽  
Clinical Trials ◽  
Medical Therapy ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure

scholarly journals Long-Term Survival for Patients With Acute Decompensated Heart Failure According to Ejection Fraction Findings

2014 ◽  
Vol 114 (6) ◽  
pp. 862-868 ◽  
Author(s):  
Andrew H. Coles ◽  
Kimberly Fisher ◽  
Chad Darling ◽  
Jorge Yarzebski ◽  
David D. McManus ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Acute Decompensated Heart Failure ◽  
Decompensated Heart Failure ◽  
Term Survival ◽  
Long Term Survival

Ultrafiltration versus intravenous loop diuretics in patients with acute decompensated heart failure: a meta-analysis of clinical trials

2017 ◽  
Vol 72 (2) ◽  
pp. 132-141 ◽  
Author(s):  
Mohamad Kabach ◽  
Hassan Alkhawam ◽  
Sachil Shah ◽  
Georges Joseph ◽  
Elie M. Donath ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Trials ◽  
Acute Decompensated Heart Failure ◽  
Meta Analysis ◽  
Decompensated Heart Failure ◽  
Loop Diuretics

scholarly journals Outcomes of Cardiac Contractility Modulation: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Ramy Mando ◽  
Akshay Goel ◽  
Fuad Habash ◽  
Marwan Saad ◽  
Karam Ayoub ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Cardiac Contractility ◽  
Mortality Data ◽  
Cardiac Contractility Modulation ◽  
All Cause Mortality

Background. Cardiac contractility modulation (CCM) is a device therapy for systolic heart failure (HF) in patients with narrow QRS. We aimed to perform an updated meta-analysis of the randomized clinical trials (RCTs) to assess the efficacy and safety of CCM therapy. Methods. We conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) between January 2001 and June 2018. Outcomes of interest were peak oxygen consumption (peak VO2), 6-Minute Walk Distance (6MWD), Minnesota Living with Heart Failure Questionnaire (MLHFQ), HF hospitalizations, cardiac arrhythmias, pacemaker/ICD malfunctioning, all-cause hospitalizations, and mortality. Data were expressed as standardized mean difference (SMD) or odds ratio (OR). Results. Four RCTs including 801 patients (CCM n = 394) were available for analysis. The mean age was 59.63 ± 0.84 years, mean ejection fraction was 29.14 ± 1.22%, and mean QRS duration was 106.23 ± 1.65 msec. Mean follow-up duration was six months. CCM was associated with improved MLWHFQ (SMD -0.69, p = 0.0008). There were no differences in HF hospitalizations (OR 0.76, p = 0.12), 6MWD (SMD 0.67, p = 0.10), arrhythmias (OR 1.40, p = 0.14), pacemaker/ICD malfunction/sensing defect (OR 2.23, p = 0.06), all-cause hospitalizations (OR 0.73, p = 0.33), or all-cause mortality (OR 1.04, p = 0.92) between the CCM and non-CCM groups. Conclusions. Short-term treatment with CCM may improve MLFHQ without significant difference in 6MWD, arrhythmic events, HF hospitalizations, all-cause hospitalizations, and all-cause mortality. There is a trend towards increased pacemaker/ICD device malfunction. Larger RCTs might be needed to determine if the CCM therapy will be beneficial with longer follow-up.

Nesiritide for Acute Decompensated Heart Failure

2002 ◽  
Vol 18 (6) ◽  
pp. 295-304
Author(s):  
Teresa S Barclay ◽  
Joanne J Kim ◽  
Audrey J Lee
Keyword(s):  
Heart Failure ◽  
Natriuretic Peptide ◽  
Acute Decompensated Heart Failure ◽  
Safety Information ◽  
Signs And Symptoms ◽  
Decompensated Heart Failure ◽  
Dependent Manner ◽  
Medline Search ◽  
Pulmonary Capillary ◽  
Study Selection

Objective: To evaluate nesiritide for the treatment of acute decompensated heart failure (HF) with respect to its pharmacology, pharmacokinetics, clinical efficacy, adverse effect profile, and outcomes. Data Source: Primary and review articles were identified by MEDLINE search (1966–March 2001). Data from the PRECEDENT trial and additional dosing/administration and safety information were obtained from Scios, Inc. Study Selection: All of the articles identified from the data sources were evaluated and all information deemed relevant was included in this review. Data Synthesis: Research into the cardiac natriuretic peptides has revealed that brain natriuretic peptide (BNP) is elevated in patients with HF and may counterregulate the pathophysiologic mechanisms involved in progression of the disease. Nesiritide (Natrecor), recombinant human BNP, is the first natriuretic peptide to be approved by the FDA for treatment of acute decompensated HF. Nesiritide is a potent venous and arterial vasodilator that reduces pulmonary capillary wedge pressure and systemic vascular resistance in a dose-dependent manner with minimal effect on heart rate. It improves signs and symptoms of HF; however, its effect on patient outcomes is unclear because of limited data. The most commonly reported adverse effects in clinical trials were dose-related hypotension and nausea. Conclusions: Nesiritide is an intravenous arterial and venous vasodilator that may be particularly useful in patients who may not tolerate the arrhythmogenic effects of dobutamine and milrinone or who cannot tolerate nitroglycerin and nitroprusside. Further well-designed comparative studies are needed to define nesiritide's place in management of acute decompensated HF.

Sign in / Sign up

Export Citation Format

Share Document