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2005, Número S3

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Arch Cardiol Mex 2005; 75 (S3)


Levosimendan: Nueva estrategia en el manejo de la falla cardíaca

González-Chon O, García LSMC, Chacón MMA, Arias SEA, Vega ZRE

Idioma: Español
Referencias bibliográficas: 44
Paginas: 130-139
Archivo PDF: 96.06 Kb.


RESUMEN

La insuficiencia cardíaca congestiva se ha considerado como un grave problema de salud. De manera tradicional, la insuficiencia cardíaca ha sido manejada con diferentes fármacos, como son los diuréticos, digital, inotrópicos del tipo de las catecolaminas y no catecolaminas; sin embargo, el manejo de los mismos, también tienen efectos secundarios en donde se incluyen la génesis de las arritmias e incluso la muerte. Un nuevo grupo de drogas recientemente ha impactado en el manejo de los pacientes con insuficiencia cardíaca aguda y crónica, estos son los sensibilizadores de calcio, que actúan incrementando la contractilidad miocárdica, sin aumentar la liberación del calcio citosólico. El levosimendan, es un sensibilizador de calcio que además de aumentar la contractilidad, posee efecto vasodilatador por activación de los canales de K(ATP), siendo ambos mecanismos los que ofrecen una opción terapéutica en la falla cardíaca. Varios estudios han comprobado la eficacia y seguridad de la droga en diferentes estadios y poblaciones, por lo que se considera en la actualidad que el uso del levosimendan es una alternativa real y segura de tratamiento en aquellos pacientes con falla ventricular aguda o crónica que necesiten soporte farmacológico endovenoso.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Foody JM, Farrel MH, Krumholz HM: Beta Blocker therapy in heart failure: scientific review. JAMA 2002; 287: 883-889.

  2. Oren RM, Pies CJ, Panther LM: Therapeutics strategies for advanced heart failure. Cardiovasc Rev Rep 1977; 18: 21-27.

  3. Mc Alister FA, Teo KK: The management of congestive Heart failure. Postgrad Med J 1977; 73: 194-200.

  4. Packer M, Carver JR, Rodeheffer RJ: Effect of oral milrinone on mortality in severe chronic heart failure. N Engl J Med 1991; 325: 1468-1475.

  5. Haikala H, Nissinen E, Etemadzadeh E: Troponin C-mediated calcium sensitization induced by levosimendan does not impair relaxation. J Cardiovasc Pharmacol 1995; 25: 794-801.

  6. Rayment I, Holden HM, Whittaker M: Structure of the actin-myosin complex and implications for muscle contraction. Science 1993; 261: 58-65.

  7. Wertman K, Drubin D: Actin Constitution: Guaranteeing the right to assemble. Science 1992; 258: 750-60.

  8. Wang Z, Gergely J, Tao T: Characterization of the Ca-triggered conformational transition in troponin C. Proc Natl Acad Sci 1992; 89: 11814-11817.

  9. Balke CW, Egan TM, Wier WG: Processes that remove calcium from the cytoplasm during excitation-contraction coupling in intact rat heart cells. J Physiol 1994; 474: 447-462.

  10. Kelley RA, Smith TW: Digoxin in heart failure implications of recent trials. J Am Coll Cardiol 1993; 22(Suppl A): 107A-112A.

  11. Leier CV, Unverferth DV: Drugs five years latter. Dobutamine. Ann Intern Med 1993; 99: 490-496.

  12. Konstam MA, Cowan SR, Weiland DS: Relative contribution of inotropic and vasodilator effects to amrinone-induced hemodynamic improvement in congestive heart failure. Am J Cardiol 1986; 74: 359-366.

  13. MacLennan DH: Molecular tools to elucidate problems in excitation-contraction coupling. Biophys J 1990; 58: 1355-1365.

  14. Feldman MD, Copeles L, Gwathmey JK: Deficient production of cyclic AMP: Pharmacologic evidence of an important cause of contractile dysfunction in patients with end-stage heart failure. Circulation 1987; 75: 331-339.

  15. Morgan JP: Abnormal intracellular modulation of calcium as a major cause of cardiac contractile dysfunction. N Engl J Med 1991; 325: 625-632.

  16. Morgan JP, Arny RE, Allen: Abnormal intracellular calcium handling, a major cause of systolic and diastolic dysfunction in ventricular myocardium from patients with heart failure. Circulation 1990; 81(Suppl III): 21S-32S.

  17. O’Connor CM, Gattis WA, Uretsky BF, Kirwood FA, McNulty SE, Grossman SH. For the FRIST Investigators: Continuous intravenous dobutamine is associated with an increased risk of death in patients with advanced heart failure: Insights fro the Flolan International Randomized Survival Trial (FRIST). Am Heart J 1999; 138: 78-86.

  18. Haikala H, Kaivola J, Nissinen E: Cardiac troponin C as a target protein for a novel calcium sensitizing drug, levosimendan. J Mol Cell Cardiol 1995; 27: 1859-1866.

  19. Haikala H, Nissinen E, Etemadzadeh E: Troponin-C-mediated calcium sensitization induced by levosimendan does not impair relaxation. J Cardiovasc Pharmacol 1995; 25: 794-801.

  20. Kaheinen P, Haikala H: Increases in diastolic coronary flow by levosimendan and pinacidil are differently mediated thorough opening of the ATP-sensitive potassium channels (Ab) 1253. J Am Coll Cardiol 1988; 31(Suppl C): 154C.

  21. Gruhn N, Nielsen-Kudsk JE, Theilgaard S: Coronary vasorelaxant effect of levosimendan, a new inodilator with calcium-sensitizing properties. J Cardiovasc Pharmacol 1998; 31: 741-749.

  22. Nieminen MS, Akkila J, Cléber FX, Lehtonen LA, Mitrovic V: Hemodynamic and Neurohumoral Effects of continuous infusion of levosimendan in patients with congestive heart failure. J Am Coll Cardiol 2000; 36: 1903-1912.

  23. Slawsky MT, Colucci WS, Gottlieb SS, Greenberg BH, Haeussleim E, Hare J, Hutchins S: Acute Hemodynamic and clinical effects of levosimendan in patients with severe heart failure. Circulation 2000; 102: 2222-2227.

  24. Grossman W: Diastolic dysfunction and congestive heart failure. Circulation 1990; 81(Suppl III): III1-III7.

  25. Gwadhmey JK, Slawsky MT, Ajar RJ, Riggs GM, Morgan JP: Role of intracellular calcium handling in force-interval relationship of human ventricular myocardium. J Clin Invest 1990; 85: 1599-1613.

  26. Janssen LMP, Datz N, Zeitz O, Hasenfuss: Levosimendan improves diastolic and systolic function in failing human myocardium. Eur J Pharmacol 2000; 404: 191-199.

  27. Sondberg S, Lilleberg J, Nieeminen MS: Hemodynamic and neurohumoral effects of levosimendan a new calcium sensitizer at rest and during exercise in healthy men. Am J Cardiol 1995; 15: 1061-1066.

  28. Bowman P, Haikala H, Paul RJ: Levosimendan, a calcium sensitizer in cardiac muscle induces relaxation in coronary smooth muscle though calcium desensitization. J Pharmacol Exp Ther 1999; 288: 316-325.

  29. Yokoshiki H, Katsube Y, Sunagawa M, Sperelakis N: The novel calcium sensitizer levosimendan activates the ATP-sensitive K channel in rat ventricular cells. J Pharmacol Exp Ther 1997; 283: 375-383.

  30. Kersten JR, Montgomery MW, Pagel PS, Warltier DC: Levosimendan a new positive inotropic drug, decreases myocardial infarct size via activation of K channels. Anesth Analg 2000; 90: 5-11.

  31. Jamali IN, Kersten JR, Pagel PS: Intracoronary levosimendan enhances contractile function of stunned myocardium. Anesth Analg 1997; 85: 23-29.

  32. Sonntag S, Opitz C, Wellnhofer E: Effects of the calcium sensitizer levosimendan on stunned myocardium after percutaneous transluminal coronary angioplasty. Eur Heart J 2000; 2: 40 Ab 387.

  33. Lillerberg, Nieminen MS, Akkila J: Effects of a new calcium sensitizer, levosimendan on haemodynamics coronary blood flow and myocardial substrate utilization early after coronary artery bypass grafting. Eur Heart J 1998; 19: 660-668.

  34. Follath F, Cleland JGF, Just H, Papp JG, Scholz H, Peuhkurinen K: 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: 196-202.

  35. Moiseyev VS, Poder P, Andrejevs N, Ruda MY, Golikov AP, Lazebnik LB, et al: Safety and efficacy of a novel calcium sensitizer levosimendan in patients with left ventricular failure due to an acute myocardial infarction. Eur Heart J 2002; 23: 1422-1432.

  36. Dwyer EM, Greenberg HM, Steimberg G: The multicenter postinfarction research group. Clinical characteristics and natural history of survivors of pulmonary congestion during acute myocardial infarction. Am J Cardiol 1989; 62: 1423-1428.

  37. Krell MJ, Kline EM, Bates ER: Intermittent, ambulatory dobutamine infusions in patients with severe congestive heart failure. Am Heart J 1986; 112: 787-791.

  38. González-Chon O: Complicaciones en la terapia postquirúrgica cardiovascular. Cap 6. Síndrome de bajo gasto cardíaco postoperatorio. México. Editorial Manual Moderno, 2002: 97-107.

  39. Nijhawan N, Nicolosi AC, Montgomery MW, Aggarwal A, Pagel PS, Warltier DC: Levosimendan enhances cardiac performance after cardiopulmonary bypass: A prospective, randomized placebo-controlled trial. J Cardiovasc Pharmacol 1999; 34: 219-228.

  40. Lilleberg J, Nieminen MS, Akkila J: Effects of a new calcium sensitizer, levosimendan on haemodynamics coronary bood flor and myocardial substrate utilization early alter coronary artery bypass grafting. Eur Heart J 1998; 19: 660-668.

  41. 2001 Heart and stroke statistical update. Dallas: American Heart Association, 2000.

  42. Jain P, Massie BM, Gattis WA, Klein L, Gheorghiade M: Current medical treatment for the exacerbation of chronic heart failure resulting in hospitalization. Am Heart J 2003; 145: S3-S17.

  43. Baing K, Mahon N, McKenna W: The pathophysiology of advanced heart failure. Am Heart J 1998; 135(Suppl): S216-S230.

  44. Jessup M, Brozena S: Heart Failure. N Engl J Med 2003; 348: 2007-2018.




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