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Safety and efficacy of levosimendan in patients with cardiac amyloidosis

      Amyloidosis is a systemic disease characterized by extracellular deposition of insoluble fibrils [
      • Wechalekar A.D.
      • Gillmore J.D.
      • Hawkins P.N.
      Systemic amyloidosis.
      ]. 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 [
      • Papp Z.
      • Édes I.
      • Fruhwald S.
      • et al.
      Levosimendan: molecular mechanisms and clinical implications: consensus of experts on the mechanisms of action of levosimendan.
      ]. Levosimendan also causes vasodilation by opening potassium channels in vascular smooth muscle cells in the arterial wall [
      • Papp Z.
      • Édes I.
      • Fruhwald S.
      • et al.
      Levosimendan: molecular mechanisms and clinical implications: consensus of experts on the mechanisms of action of levosimendan.
      ]. This action is responsible for the main adverse effects of levosimendan, namely hypotension and increased arrhythmogenic risk because of hypokalemia [
      • Zhou S.
      • Zhang L.
      • Li J.
      Effect of levosimendan in patients with acute decompensated heart failure: a meta-analysis.
      ]. Levosimendan has positive effects on systemic and pulmonary hemodynamics and the relief of HF symptoms, although the prognostic benefit in HF is uncertain [
      • Gong B.
      • Li Z.
      • Yat Wong P.C.
      Levosimendan treatment for heart failure: a systematic review and meta-analysis.
      ]. Evidence on levosimendan in CA is currently limited to retrospective studies or case reports on patients with cardiogenic shock or end-stage HF [
      • d'Humières T.
      • Fard D.
      • Damy T.
      • et al.
      Outcome of patients with cardiac amyloidosis admitted to an intensive care unit for acute heart failure.
      ,
      • Panhwar M.S.
      • Al-Kindi S.
      • Oliveira G.H.
      • et al.
      Successful use of palliative inotrope therapy in end-stage cardiac ATTR amyloidosis.
      ].

      Keywords

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