December 2018 post

12/3/2018 8:00:00 AM

Levosimendan Ends 2018 on a High Note

Earlier this year (May 27-28), the Heart Failure 2018 congress of the European Society of Cardiology-Heart Failure Association convened in Vienna, Austria.  A series of tutorials delivered by experts from nine European countries examined how to use levosimendan safely and effectively in acute and advanced heart failure, including in the context of renal dysfunction.

Contributors to that lecture series have now distilled into print their experience and views on the position of levosimendan in the management of acute and advanced heart failure in a review published in Cardiovascular Drugs and Therapy (Bouchez S et al. 2018 Nov 6. doi: 10.1007/s10557-018-6838-2. [Epub ahead of print]). It seems fitting that we should conclude our monthly blog posts for 2018 with a brief summary of this excellent tour d’horizon from a group of notable and respected practitioners in this complex field.

A series of major points emerged from this review.

(1)  Meta-analyses of levosimendan data in various settings, including AHF and AdHF, indicated a trend towards a survival benefit that reached statistical significance in some investigations, though not all. Of note, however, none of these meta-analyses produced any indication that the use of levosimendan is associated with an increase of mortality, whereas a worsening impact on survival has been reported for other inotropes or inodilators.

(2)  In advanced heart failure meta-analysis indicates a clear and consistent effect of levosimendan to reduce re-hospitalizations. Given that patients with AdHF may comprise up to 10% of the overall heart failure population these benefits may be accessible to substantial numbers of patients.

(3)  Bouchez and colleagues re-iterate the advice of the authors of the 2016 ESC guidelines on acute and chronic heart failure, who recommend use of levosimendan in cases where there is concomitant use of beta-blockers.

(4)  Levosimendan both in the acute setting and in the repetitive/intermittent context of AdHF appears to a promising option to improve renal perfusion or to reverse or ameliorate renal dysfunction but further controlled trials are needed to confirm the status of levosimendan for this purpose. In particular, they emphasize the conclusions of Lannemyr et al. who recently suggested that levosimendan “could be the preferred inotropic agent for treatment of the cardiorenal syndrome”. (J Am Heart Assoc. 2018;7: e008455. doi: 10.1161/JAHA.117.008455.)

These are substantial attainments for any drug in these areas of heart failure therapy and they confirm levosimendan as a uniquely-configured resource for this field. Join us again in 2019 for the next chapters in the development of this remarkable agent.