Short Review

Levosimendan in sepsis

Ugur Koca* and Burcu Tanay Demirdöven

Published: 29 May, 2020 | Volume 5 - Issue 1 | Pages: 020-021

Levosimendan is a calcium sensitizer and its inotropic effect is mainly attributed to the troponin C of the myocardial fine filaments with calcium. Levosimendan also inhibits phosphodiesterase III. In contrast to inotropic effects, this does not increase calcium entry into the cell, which explains that levosimendan does not worsen myocardial diastolic dysfunction and may even improve diastolic function. Levosimendan does not increase the use of myocardial oxygen and increases coronary vasodilation and myocardial oxygen delivery. Levosimendan opens potassium channels and causes hyperpolarization in smooth muscle cell membrane, thus causing vasodilatation [1]. Levosimendan has also been reported to have antiinflammatory [2,3] and antiapoptotic effects [2].

Read Full Article HTML DOI: 10.29328/journal.jcicm.1001030 Cite this Article Read Full Article PDF


  1. Pierrakos C, Velissaris D, Franchi F, Muzzi L, Karanikolas M, et al. Levosimendan in critical illness: a literature review. J Clin Med Res. 2014; 6: 75-85. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24578748
  2. Parissis JT, Adamopoulos S, Antoniades C, Kostakis G, Rigas A, et al. Effectsof levosimendan on circulating pro-inflammatory cytokinesand soluble apoptosis mediators in patients with decompensated advanced heart failure. Am J Cardiol. 2004; 93: 1309-1312. PubMed: http://www.ncbi.nlm.nih.gov/pubmed/15135713
  3. Latva-Hirvela J, Kyto V, Saraste A, Vuorinen T, LevijokiJ, et al. Effects of levosimendan in experimental acute coxsackievirus myocarditis. Eur J Clin Invest. 2009; 39: 876-882. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/19772522
  4. Belletti A, Castro ML, Silvetti S, Greco T, Biondi-Zoccai G, et al. The Effect of inotropes and vasopressors on mortality: a meta-analysis of randomized clinical trials.Br J Anaesth. 2015; 115: 656-675. PubMed: https://pubmed.ncbi.nlm.nih.gov/26475799
  5. Willem-Jan M Schellekens, Hieronymus WH van Hees, Marianne Linkels, Dekhuijzen PNR, et al. Levosimendan affects oxidative and inflammatory pathways in the diaphragm of ventilated endotoxemic mice. Critical Care 2015; 19: 69. https://pubmed.ncbi.nlm.nih.gov/25888356/
  6. Hajjej Z, Bilel M, Sellami W, Labbene I, Morelli A, et al. Effects of levosimendan on cellular metabolic alterations in patients with septic shock: arandomized controlled pilot study. Shock. 2017; 48: 307-312. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28234790
  7. Memiş D, Inal MT, Sut N. The effects of levosimendan vs dobutamine added todopamine on liver functions assessed with noninvasive liver function monitoring in patients with septic shock. J Crit Care. 2012; 27: 318.e1–318.e6 PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21855289
  8. Morelli A, Donati A, Ertmer C, Rehberg S, Lange M, et al. Levosimendan for resuscitating the microcirculation in patients with septic shock: A randomized controlled study. Crit Care. 2010; 14: R232. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21182783
  9. Hasslacher J, Bijuklic K, Bertocchi C, Kountchev J, Bellmann R, et al. Levosimendan inhibits release of reactive oxygen species in polymorphonuclear leukocytes in vitro and in patients with acute heart failure and septic shock: a prospective observational study. Crit Care. 2011; 15: R166. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21749676
  10. Wang Q, Yokoo H, Takashina M, Sakata K, Ohashi W, et al. Anti-Inflammatory Profile of Levosimendanin Cecal Ligation-Induced Septic Mice and in Lipopolysaccharide-Stimulated Macrophages. Crit Care Med. 2015; 43: e508 e520. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26468714
  11. Erbüyün K, Tok D, Vatansever S, Ok G, Türköz E, et al. Levosimendan up-regulates transforming growth factor-beta and Smad signaling in the aorta in the early stage of sepsis Ulus Travma Acil Cerrahi Derg. 2010; 16: 293-299. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/20849043
  12. Wagner S, Schurmann S, Hein S, Schüttler J, Friedrich O. Septic cardiomyopathy in rat LPS-induced endotoxemia: relative contribution of cellular diastolic Ca2+ removal pathways, myofibrillar biomechanics properties and action of the cardiotonic drug levosimendan. Basic Res Cardiol. 2015: 110: 50. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26243667
  13. Schellekens WJM, van Hees HWH, Linkels M, Dekhuijzen PNR, Scheffer GJ, et al. Levosimendan affects oxidative and inflammatory pathways in the diaphragm of ventilated endotoxemic mice. Crit Care. 2015; 19: 69. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25888356

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More