Levosimendan reverted severe pulmonary hypertension in one patient on waiting list for heart transplantation

摘要

Levosimendan is a calcium-sensitizing agent with positive inotropic and vasodilatory action. Its effect relates to its specific interaction with the calcium-sensor troponin C molecule in the cardiac myofilaments. Levosimendan may be better than dobutamine for treating patients on beta-blocker therapy when hospitalized due to worsening heart failure (HF) requiring inotropic support. Its hemodynamic efficacy on pulmonary capillary wedge pressure and cardiac index, that may persist beyond actual infusion time due to transformation of levosimendan into an active metabolite, has led to hypothesize that repeated treatments could be useful in patients with advanced/refractory chronic HF. However, the mechanisms and time course of clinical and hemodynamic effects of this treatment strategy are not completely elucidated. Here, we present the case of a super-responder to levosimendan who reverted severe secondary pulmonary hypertension (PH) after a 24-hour treatment, and was subsequently managed with repeated infusions.