Levosimendan: evolution over last two decades

Kishore Gupta, Dhiren Shah, Dhaval Naik


Levosimendan was maiden agent at the time of its emergence, promoting inotropy mainly through calcium sensitization of cardiac troponin C (cTnC). Levosimendan seems a lucrative option but has not demonstrated a clear superiority to other inotropes in well-designed trials. We searched the PubMed database and reviewed the pertinent studies published till 2021 and summarized various trials/studies to come to a consensus regarding its indications in cardiac patients. Patients with decompensated heart failure requiring inotropic support and receiving beta-blockers represent most widely accepted indication. Levosimendan infusions are increasingly used to facilitate extracorporeal membrane oxygenation (ECMO) weaning and avoiding hospitalizations in patients with end-stage heart failure. Levosimendan doesn’t seem to have long term survival benefit in ventricular dysfunction patients undergoing surgery. The evidence supporting the role in right ventricular failure is not well-established. These lines of evidence require further investigation and their clinical significance needs to be evaluated in specifically designed prospective trials.


Levosimendan, Heart failure, ECMO, LV dysfunction, Sepsis, Cardiorenal syndrome

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