Amyloidosis is a systemic disease characterized by extracellular deposition of insoluble
fibrils [
[1]
]. Cardiac amyloidosis (CA) is common in both immunoglobulin light-chain (AL) and transthyretin
amyloidosis (ATTR), and usually manifests with signs and symptoms of heart failure
(HF), which may require inotropic support. Levosimendan enhances the contractile response
to intracellular calcium, and does not increase myocardial oxygen consumption [
[2]
]. Levosimendan also causes vasodilation by opening potassium channels in vascular
smooth muscle cells in the arterial wall [
[2]
]. This action is responsible for the main adverse effects of levosimendan, namely
hypotension and increased arrhythmogenic risk because of hypokalemia [
[3]
]. Levosimendan has positive effects on systemic and pulmonary hemodynamics and the
relief of HF symptoms, although the prognostic benefit in HF is uncertain [
[4]
]. Evidence on levosimendan in CA is currently limited to retrospective studies or
case reports on patients with cardiogenic shock or end-stage HF [
[5]
,
[6]
].Keywords
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References
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- 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.Eur Heart J. 2016; 37: 2129-2200
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- Safety and tolerability of neurohormonal antagonism in cardiac amyloidosis.Eur J Int Med. 2020; https://doi.org/10.1016/j.ejim.2020.05.015
Article info
Publication history
Published online: July 03, 2020
Accepted:
June 30,
2020
Received:
June 22,
2020
Identification
Copyright
© 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
