Browsing by Subject "REPETITIVE USE"

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  • Farmakis, Dimitrios; Agostoni, Piergiuseppe; Baholli, Loant; Bautin, Andrei; Comin-Colet, Josep; Crespo-Leiro, Maria G.; Fedele, Francesco; García-Pinilla, Jose Manuel; Giannakoulas, George; Grigioni, Francesco; Gruchała, Marcin; Gustafsson, Finn; Harjola, Veli-Pekka; Hasin, Tal; Herpain, Antoine; Iliodromitis, Efstathios K.; Karason, Kristjan; Kivikko, Matti; Liaudet, Lucas; Ljubas-Maček, Jana; Marini, Marco; Masip, Josep; Mebazaa, Alexandre; Nikolaou, Maria; Ostadal, Petr; Põder, Pentti; Pollesello, Piero; Polyzogopoulou, Eftihia; Pölzl, Gerhard; Tschope, Carsten; Varpula, Marjut; von Lewinski, Dirk; Vrtovec, Bojan; Yilmaz, Mehmet Birhan; Zima, Endre; Parissis, John (2019)
    Inotropes aim at increasing cardiac output by enhancing cardiac contractility. They constitute the third pharmacological pillar in the treatment of patients with decompensated heart failure, the other two being diuretics and vasodilators. Three classes of parenterally administered inotropes are currently indicated for decompensated heart failure, (i) the beta adrenergic agonists, including dopamine and dobutamine and also the catecholamines epinephrine and norepinephrine, (ii) the phosphodiesterase III inhibitor milrinone and (iii) the calcium sensitizer levosimendan. These three families of drugs share some pharmacologic traits, but differ profoundly in many of their pleiotropic effects. Identifying the patients in need of inotropic support and selecting the proper inotrope in each case remain challenging. The present consensus, derived by a panel meeting of experts from 21 countries, aims at addressing this very issue in the setting of both acute and advanced heart failure. (C) 2019 The Authors. Published by Elsevier B.V.
  • Bouchez, S.; Fedele, F.; Giannakoulas, G.; Gustafsson, F.; Harjola, V. -P.; Karason, K.; Kivikko, M.; von Lewinski, D.; Oliva, F.; Papp, Z.; Parissis, J.; Pollesello, Piero; Pölzl, G.; Tschöpe, C. (2018)
    Levosimendan, a calcium sensitizer and potassium channel-opener, is widely appreciated by many specialist heart failure practitioners for its effects on systemic and pulmonary hemodynamics and for the relief of symptoms of acute heart failure. The drug's impact on mortality in large randomized controlled trials has been inconsistent or inconclusive but, in contrast to conventional inotropes, there have been no indications of worsened survival and some signals of improved heart failure-related quality of life. For this reason, levosimendan has been proposed as a safer inodilator option than traditional agents in settings, such as advanced heart failure. Positive effects of levosimendan on renal function have also been described. At the HEART FAILURE 2018 congress of the Heart Failure Association of the European Society of Cardiology, safe and effective use levosimendan in acute and advanced heart failure was examined in a series of expert tutorials. The proceedings of those tutorials are summarized in this review, with special reference to advanced heart failure and heart failure with concomitant renal dysfunction. Meta-analysis of clinical trials data is supportive of a renal-protective effect of levosimendan, while physiological observations suggest that this effect is exerted at least in part via organ-specific effects that may include selective vasodilation of glomerular afferent arterioles and increased renal blood flow, with no compromise of renal oxygenation. These lines of evidence require further investigation and their clinical significance needs to be evaluated in specifically designed prospective trials.