Levosimendan beyond inotropy and acute heart failure: Evidence of pleiotropic effects on the heart and other organs: An expert panel position paper

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Title: Levosimendan beyond inotropy and acute heart failure: Evidence of pleiotropic effects on the heart and other organs: An expert panel position paper
Authors: Farmakis, D
Alvarez, J
Gal, TB
Brito, D
Fedele, F
Fonseca, C
Gordon, AC
Gotsman, I
Grossini, E
Guarracino, F
Harjola, V-P
Hellman, Y
Heunks, L
Ivancan, V
Karavidas, A
Kivikko, M
Lomivorotov, V
Longrois, D
Masip, J
Metra, M
Morelli, A
Nikolaou, M
Papp, Z
Parkhomenko, A
Poelzl, G
Pollesello, P
Ravn, HB
Rex, S
Riha, H
Ricksten, S-E
Schwinger, RHG
Vrtovec, B
Yilmaz, MB
Zielinska, M
Parissis, J
Item Type: Journal Article
Abstract: Levosimendan is a positive inotrope with vasodilating properties (inodilator) indicated for decompensated heart failure (HF) patients with low cardiac output. Accumulated evidence supports several pleiotropic effects of levosimendan beyond inotropy, the heart and decompensated HF. Those effects are not readily explained by cardiac function enhancement and seem to be related to additional properties of the drug such as anti-inflammatory, anti-oxidative and anti-apoptotic ones. Mechanistic and proof-of-concept studies are still required to clarify the underlying mechanisms involved, while properly designed clinical trials are warranted to translate preclinical or early-phase clinical data into more robust clinical evidence. The present position paper, derived by a panel of 35 experts in the field of cardiology, cardiac anesthesiology, intensive care medicine, cardiac physiology, and cardiovascular pharmacology from 22 European countries, compiles the existing evidence on the pleiotropic effects of levosimendan, identifies potential novel areas of clinical application and defines the corresponding gaps in evidence and the required research efforts to address those gaps.
Issue Date: 29-Jul-2016
Date of Acceptance: 28-Jul-2016
ISSN: 1874-1754
Publisher: Elsevier
Start Page: 303
End Page: 312
Journal / Book Title: International Journal of Cardiology
Volume: 222
Copyright Statement: © 2016 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY-NC-ND license (
Keywords: Cardiogenic shock
Heart failure
Organ protection
Cardiovascular Medicine And Haematology
Publication Status: Published
Open Access location:
Appears in Collections:Division of Surgery
Faculty of Medicine

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