Perrone Sergio V, Kaplinsky Edgardo J
Heart Failure, Fundacion para la Lucha contra las Enfermedades Neurologicas de la Infancia, Instituto de Investigaciones Neurologicas Raul Carrea, FLENI, Montañeses 2325, Buenos Aires (C1428AQK), Argentina.
Int J Cardiol. 2005 Sep 1;103(3):248-55. doi: 10.1016/j.ijcard.2004.12.012.
The clinician's primary objective in treating a patient with decompensated heart failure is rapid and effective stabilization. This goal often is achieved through the use of inotropic support. Classic inotropic agents (beta-adrenergic agonists and phosphodiesterase III inhibitors) can provide short-term hemodynamic benefits, but their long-term use has been correlated with poor survival rates. Calcium sensitizers comprise a new drug class that offers hemodynamic and symptomatic improvements without increasing cAMP and intracellular calcium concentrations. These agents enhance contractility without a concurrent increase in the risk of cardiac events and thus represent a significant improvement over classic positive inotropic agents. Levosimendan is the most potent calcium sensitizer to date, exhibiting a unique dual mechanism of action that combines a positive inotropic action mediated via calcium sensitization and a vasodilator property via ATP-dependent potassium channels. Available clinical data suggest that calcium sensitizer agents represent a promising class of inotropic agents in a field that has seen few advances in recent decades.
治疗失代偿性心力衰竭患者时，临床医生的主要目标是迅速有效地实现病情稳定。这一目标通常通过使用正性肌力支持来实现。经典的正性肌力药物（β-肾上腺素能激动剂和磷酸二酯酶III抑制剂）可提供短期血流动力学益处，但其长期使用与较差的生存率相关。钙增敏剂是一类新型药物，可改善血流动力学和症状，而不增加环磷酸腺苷（cAMP）和细胞内钙浓度。这些药物增强心肌收缩力，同时不会增加心脏事件的风险，因此相较于经典的正性肌力药物有显著改进。左西孟旦是迄今为止效力最强的钙增敏剂，具有独特的双重作用机制，既通过钙增敏介导正性肌力作用，又通过ATP依赖性钾通道发挥血管舒张特性。现有临床数据表明，在近几十年来进展寥寥的领域中，钙增敏剂类药物是一类很有前景的正性肌力药物。
