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Levosimendan studies


Claudia Cheng

1.      Slawsky MT, Colucci WS, Gottlieb SS et al. Acute hemodynamic and clinical effects of levosimendan in patients with severe heart failure. Circulation 2000;102:2222

  • Findings: compared to placebo, IV levosimendan increases stroke volume by 28%, cardiac index by 39%, dose-dependent reduction in PCWP, right atrial and pulmonary artery pressures, decrease symptoms of dyspnoea and fatigue.

2.      Kivikko M, Lehtonen L, Colucci WS. Sustained hemodynamic effects of intravenous levosimendan. Circulation 2003;107:81

  • Haemodynamic effects maintained during infusion for 48 hours. Discontinuing infusion at 24 hours did not appear to attenuate benefit seen at 48 hours (?active metabolite)

3.      Nieminen MS, Akkila J, Hasenfuss G et al. Hemodynamic and neurohumoral effects of continuous infusion of levosimendan in patients with congestive heart failure. J Am Coll Cardiol 2000

  • Dose ranging study
  • Effect on cardiac output, stroke volume and PCWP are dose dependent
  • Seen at doses of 0.05 to 0.6 µg/kg per minute
  • Higher doses >0.2 µg/kg per minute associated with higher incidence of side effects eg. headache, nausea and hypotension

4.      Follath F, Cleland JG, Just H et al. Efficacy and safety of intravenous levosimendan compared with dobutamine in severe low-output heart failure (the LIDO study): a randomized double-blind trial. Lancet 2002;360:196

  • Compared treatment with levosimendan and dobutamine for 24 hours in 203 patients with decompensated heart failure
  • Loading dose with levosimendan 24 µg/kg over 10 minutes, infusion with 0.1 µg/kg/min compared with dobutamine 5 µg/kg/min without loading dose
  • Haemodynamic endpoints =  35% increase cardiac index and >/= 25% reduction in PCWP at 24 hours. Achieved in 28% of levosimendan group compared to 15% in dobutamine group
  • Effect not attenuated by concurrent therapy with a beta blocker in contrast with dobutamine

Mortality benefit 

  • LIDO trial: reduction  in mortality at 1 and 6 months
  • Moiseyev VS, Poder P, Andrejevs N et al. Safety and efficacy of a novel calcium sensitizer, levosimendan in patients with left ventricular failure due to an acute myocardial infarction. A randomized, placebo-controlled, double-blind study (RUSSLAN). Eur Heart J 2002;23:1422.
    •  Significant improved mortality at 1 day and 2 weeks. Trend towards improved mortality at 6 months

© Claudia Cheng, December 2003

©Charles Gomersall, April, 2014 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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