M S Nieminen1, J Altenberger2, T Ben-Gal3, A Böhmer4, J Comin-Colet5, K Dickstein6, I Edes7, F Fedele8, C Fonseca9, M J García-González10, G Giannakoulas11, Z Iakobishvili12, P Jääskeläinen13, A Karavidas14, J Kettner15, M Kivikko16, L H Lund17, S T Matskeplishvili18, M Metra19, F Morandi20, F Oliva21, A Parkhomenko22, J Parissis23, P Pollesello16, G Pölzl24, R H G Schwinger25, J Segovia26, M Seidel27, B Vrtovec28, G Wikström29. 1. Helsinki University Hospital, Helsinki, Finland. Electronic address: markku.nieminen@hus.fi. 2. Pensionsversicherungsanstalt SKA-RZ Großgmain für Herz-Kreislauf- und neurologische Erkrankungen, Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversitaet, Großgmain, Austria. 3. Heart Failure Unit and Heart Transplant Clinic, Rabin Medical Center, Petah Tikva, Israel. 4. LK Krems, Abteilung für Innere Medizin mit kardiologischem Schwerpunkt, Krems, Austria. 5. Heart Failure Program, Cardiology Department, Hospital del Mar, Barcelona, Spain. 6. Stavanger University Hospital, University of Bergen, Stavanger, Norway. 7. Institute of Cardiology, Medical and Health Center, University of Debrecen, Debrecen, Hungary. 8. Department of Cardiovascular, Respiratory, Nephrology and Geriatric Sciences, 'La Sapienza' University of Rome, Rome, Italy. 9. Heart Failure Unit, Hospital S. Francisco Xavier/CHLO, Faculdade de Ciências Médicas Universidade Nova de Lisboa, Lisbon, Portugal; 10. Department of Cardiology, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Sta. Cruz de Tenerife, Spain. 11. Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece. 12. Emergency Cardiology Services, Cardiac Intensive Care Unit, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel. 13. Heart Center, Kuopio University Hospital, Kuopio, Finland. 14. Cardiology Clinic of the Gennimatas General Hospital of Athens, Athens, Greece. 15. Institut klinické a experimentální medicíny klinika kardiologie IKEM, oddělení akutní kardiologie KK IKEM, Vídeňská, Prague, Czech Republic. 16. Orion Pharma, Espoo, Finland. 17. Unit of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden. 18. Scientific Centre of Cardiovascular Surgery of Bakulev, Moscow, Russia. 19. Cardiology Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy. 20. Department of Cardiovascular Science, University of Insubria, Circolo Hospital and Macchi Foundation, Varese, Italy. 21. 'A. De Gasperis' Cardiac Failure and Transplantology Department, Niguarda Ca'Granda Hospital Milan, Milan, Italy. 22. Strazhesko Institute of Cardiology, National Scientific Centre, Kiev, Ukraine. 23. Second Cardiology Department and Heart Failure Unit, Attikon Teaching Hospital, Athens, Greece. 24. Department of Internal Medicine III, University of Innsbruck, Austria. 25. Medizinische Klinik II, Klinikum Weiden, Akademisches Lehrkrankenhaus der Universität Regensburg, Germany. 26. Unidad de Insuficiencia Cardiaca, Trasplante e Hipertensión Pulmonar, So. Cardiología, Hospital Univ. Puerta de Hierro, Madrid, Spain. 27. Unfallkrankenhaus Berlin, Klinik für Innere Medizin, Berlin, Germany. 28. Clinical Department of Cardiology, University Clinical Centre Ljubljana, Ljubljana, Slovenia. 29. Cardiology, Institute of Medical Sciences, Uppsala University, Uppsala, Sweden.
Abstract
BACKGROUND: The intravenous inodilator levosimendan was developed for the treatment of patients with acutely decompensated heart failure. In the last decade scientific and clinical interest has arisen for its repetitive or intermittent use in patients with advanced chronic, but not necessarily acutely decompensated, heart failure. Recent studies have suggested long-lasting favourable effects of levosimendan when administered repetitively, in terms of haemodynamic parameters, neurohormonal and inflammatory markers, and clinical outcomes. The existing data, however, requires further exploration to allow for definitive conclusions on the safety and clinical efficacy of repetitive use of levosimendan. METHODS AND RESULTS: A panel of 30 experts from 15 countries convened to review and discuss the existing data, and agreed on the patient groups that can be considered to potentially benefit from intermittent treatment with levosimendan. The panel gave recommendations regarding patient dosing and monitoring, derived from the available evidence and from clinical experience. CONCLUSIONS: The current data suggest that in selected patients and support out-of-hospital care, intermittent/repetitive levosimendan can be used in advanced heart failure to maintain patient stability. Further studies are needed to focus on morbidity and mortality outcomes, dosing intervals, and patient monitoring. Recommendations for the design of further clinical studies are made.
BACKGROUND: The intravenous inodilator levosimendan was developed for the treatment of patients with acutely decompensated heart failure. In the last decade scientific and clinical interest has arisen for its repetitive or intermittent use in patients with advanced chronic, but not necessarily acutely decompensated, heart failure. Recent studies have suggested long-lasting favourable effects of levosimendan when administered repetitively, in terms of haemodynamic parameters, neurohormonal and inflammatory markers, and clinical outcomes. The existing data, however, requires further exploration to allow for definitive conclusions on the safety and clinical efficacy of repetitive use of levosimendan. METHODS AND RESULTS: A panel of 30 experts from 15 countries convened to review and discuss the existing data, and agreed on the patient groups that can be considered to potentially benefit from intermittent treatment with levosimendan. The panel gave recommendations regarding patient dosing and monitoring, derived from the available evidence and from clinical experience. CONCLUSIONS: The current data suggest that in selected patients and support out-of-hospital care, intermittent/repetitive levosimendan can be used in advanced heart failure to maintain patient stability. Further studies are needed to focus on morbidity and mortality outcomes, dosing intervals, and patient monitoring. Recommendations for the design of further clinical studies are made.
Authors: Julia Schumann; Eva C Henrich; Hellen Strobl; Roland Prondzinsky; Sophie Weiche; Holger Thiele; Karl Werdan; Stefan Frantz; Susanne Unverzagt Journal: Cochrane Database Syst Rev Date: 2018-01-29
Authors: Johann Altenberger; Finn Gustafsson; Veli-Pekka Harjola; Kristjan Karason; Detlef Kindgen-Milles; Matti Kivikko; Gabriella Malfatto; Zoltán Papp; John Parissis; Piero Pollesello; Gerhard Pölzl; Carsten Tschöpe Journal: J Cardiovasc Pharmacol Date: 2018-03 Impact factor: 3.105
Authors: Emil Najjar; Marcus Stålhberg; Camilla Hage; Erica Ottenblad; Aristomenis Manouras; Ida Haugen Löfman; Lars H Lund Journal: ESC Heart Fail Date: 2018-02-22
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