Levosimendan: A Novel Inotropic Agent for Treatment of Acute,

The most common reason for hospitalization among in-dividuals>65 years of age is acute, decompensated heart failure.1 Because of the aging population and better survival in other forms of heart disease, heart failure is one of the only cardiac diagnoses for which the incidence is in-creasing. The associated hemodynamic derangements are often treated with positive inotropic drugs. Currently avail-able intravenous inotropes are dobutamine, a β-agonist, and milrinone, a phosphodiesterase inhibitor. Short-term use of milrinone had no effect on length of hospitalization, 60-day mortality, and the composite of death and readmis-sion compared with placebo.2 Long-term use of almost all inotropic drugs led to increased mortality.3 Digoxin is the exception, although its hemodynamic effects and useful-ness in acute, decompensated heart failure are modest.4 Another disadvantage with using dobutamine and milri-none is the proarrhythmic effects.2,3 Levosimendan has been approved for use in Europe for intravenous administration in treatment of acute, decom-pensated heart failure. The drug is a calcium sensitizer, which has a unique mechanism of action that differs from that of β-agonists and phosphodiesterase inhibitors. It may offer a favorable risk–benefit ratio in the treatment of acute heart failure when inotropic support is needed. Levosimen-dan was developed by Orion Pharmaceutica, Espoo, Fin