Heart Failure Clinic and Second Cardiology Department, Attikon University Hospital, Maroussi, Athens, Greece.
Heart Fail Rev. 2009 Dec;14(4):265-75. doi: 10.1007/s10741-008-9128-4. Epub 2008 Dec 20.
Levosimendan is a new cardiac enhancer that exerts positive inotropic effects on the failing heart mediated by calcium sensitization of contractile proteins as well as peripheral vasodilatory effects mediated by opening of ATP-sensitive potassium channels in vascular smooth-muscle cells. Levosimendan is the most well-studied calcium sensitizer in the real clinical practice, producing greater hemodynamic and symptomatic improvement in patients with acute heart failure syndromes (AHFS) than those with traditional inotropes. Immunomodulatory and anti-apoptotic properties of levosimendan may be an additional biologic mechanism that prevents further cytotoxic and hemodynamic consequences of abnormal immune and neurohormonal responses in AHFS. Recent mortality trials showed that levosimendan does not improve short- and long-term prognosis in AHFS in comparison to dobutamine or placebo. However, in patients with a previous history of CHF and on beta-blocker on admission, levosimendan seems to have a beneficial effect on short-term mortality. According to the recent guidelines of the European Society of Cardiology, levosimendan is indicated in patients with symptomatic low cardiac output HF secondary to cardiac systolic dysfunction without severe hypotension (Class IIa, Level of Evidence B).
左西孟旦是一种新型心脏增强剂，通过收缩蛋白的钙敏化和血管平滑肌细胞中 ATP 敏感性钾通道的开放，对衰竭的心脏发挥正性肌力作用，并具有外周血管舒张作用。左西孟旦是目前临床实践中研究最充分的钙敏化剂，与传统正性肌力药相比，它能更大程度地改善急性心力衰竭综合征（AHFS）患者的血液动力学和症状。左西孟旦的免疫调节和抗凋亡特性可能是一种额外的生物学机制，可防止 AHFS 中异常免疫和神经激素反应的进一步细胞毒性和血液动力学后果。最近的死亡率试验表明，与多巴酚丁胺或安慰剂相比，左西孟旦并不能改善 AHFS 的短期和长期预后。然而，对于有 CHF 既往史和入院时使用β受体阻滞剂的患者，左西孟旦似乎对短期死亡率有有益影响。根据欧洲心脏病学会的最新指南，左西孟旦适用于因心脏收缩功能障碍导致的有症状的低心输出量 HF 且无严重低血压的患者（Ⅱa 类，证据水平 B）。
