The role of levosimendan in acute heart failure complicating acute coronary syndrome

A review and expert consensus opinion

Markku S. Nieminen, Michael Buerke, Alain Cohen-Solál, Susana Costa, István Édes, Alexey Erlikh, Fatima Franco, Charles Gibson, Vojka Gorjup, Fabio Guarracino, Finn Gustafsson, Veli Pekka Harjola, Trygve Husebye, Kristjan Karason, Igor Katsytadze, Sundeep Kaul, Matti Kivikko, Giancarlo Marenzi, Josep Masip, Simon Matskeplishvili & 14 others Alexandre Mebazaa, Jacob E. Møller, Jadwiga Nessler, Bohdan Nessler, Argyrios Ntalianis, Fabrizio Oliva, Emel Pichler-Cetin, Pentti Põder, Alejandro Recio-Mayoral, Steffen Rex, Richard Rokyta, Ruth H. Strasser, Endre Zima, Piero Pollesello

Research output: Contribution to journalReview article

24 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)150-157
Number of pages8
JournalInternational Journal of Cardiology
Volume218
DOIs
Publication statusPublished - Sep 1 2016

Fingerprint

Expert Testimony
Acute Coronary Syndrome
Heart Failure
Cardiogenic Shock
Hypotension
Vasoconstrictor Agents
Diuretics
Adrenergic Agents
Observational Studies
Registries
Coronary Artery Disease
Anti-Inflammatory Agents
Therapeutics
Perfusion
Hemodynamics
simendan
Clinical Trials
Guidelines
Blood Pressure
Lung

Keywords

  • Acute coronary syndrome
  • Cardiogenic shock
  • Heart failure
  • Levosimendan

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine

Cite this

The role of levosimendan in acute heart failure complicating acute coronary syndrome : A review and expert consensus opinion. / Nieminen, Markku S.; Buerke, Michael; Cohen-Solál, Alain; Costa, Susana; Édes, István; Erlikh, Alexey; Franco, Fatima; Gibson, Charles; Gorjup, Vojka; Guarracino, Fabio; Gustafsson, Finn; Harjola, Veli Pekka; Husebye, Trygve; Karason, Kristjan; Katsytadze, Igor; Kaul, Sundeep; Kivikko, Matti; Marenzi, Giancarlo; Masip, Josep; Matskeplishvili, Simon; Mebazaa, Alexandre; Møller, Jacob E.; Nessler, Jadwiga; Nessler, Bohdan; Ntalianis, Argyrios; Oliva, Fabrizio; Pichler-Cetin, Emel; Põder, Pentti; Recio-Mayoral, Alejandro; Rex, Steffen; Rokyta, Richard; Strasser, Ruth H.; Zima, Endre; Pollesello, Piero.

In: International Journal of Cardiology, Vol. 218, 01.09.2016, p. 150-157.

Research output: Contribution to journalReview article

Nieminen, MS, Buerke, M, Cohen-Solál, A, Costa, S, Édes, I, Erlikh, A, Franco, F, Gibson, C, Gorjup, V, Guarracino, F, Gustafsson, F, Harjola, VP, Husebye, T, Karason, K, Katsytadze, I, Kaul, S, Kivikko, M, Marenzi, G, Masip, J, Matskeplishvili, S, Mebazaa, A, Møller, JE, Nessler, J, Nessler, B, Ntalianis, A, Oliva, F, Pichler-Cetin, E, Põder, P, Recio-Mayoral, A, Rex, S, Rokyta, R, Strasser, RH, Zima, E & Pollesello, P 2016, 'The role of levosimendan in acute heart failure complicating acute coronary syndrome: A review and expert consensus opinion', International Journal of Cardiology, vol. 218, pp. 150-157. https://doi.org/10.1016/j.ijcard.2016.05.009
Nieminen, Markku S. ; Buerke, Michael ; Cohen-Solál, Alain ; Costa, Susana ; Édes, István ; Erlikh, Alexey ; Franco, Fatima ; Gibson, Charles ; Gorjup, Vojka ; Guarracino, Fabio ; Gustafsson, Finn ; Harjola, Veli Pekka ; Husebye, Trygve ; Karason, Kristjan ; Katsytadze, Igor ; Kaul, Sundeep ; Kivikko, Matti ; Marenzi, Giancarlo ; Masip, Josep ; Matskeplishvili, Simon ; Mebazaa, Alexandre ; Møller, Jacob E. ; Nessler, Jadwiga ; Nessler, Bohdan ; Ntalianis, Argyrios ; Oliva, Fabrizio ; Pichler-Cetin, Emel ; Põder, Pentti ; Recio-Mayoral, Alejandro ; Rex, Steffen ; Rokyta, Richard ; Strasser, Ruth H. ; Zima, Endre ; Pollesello, Piero. / The role of levosimendan in acute heart failure complicating acute coronary syndrome : A review and expert consensus opinion. In: International Journal of Cardiology. 2016 ; Vol. 218. pp. 150-157.
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