Pleiotropic effects of levosimendan on the heart and other organs

Levosimendan is a cardiotonic drug with vasodilating properties. The main mechanisms of its action include increased sensitivity of contractile proteins in cardiomyocytes to calcium and its ability to open ATP-dependent potassium channels in the smooth muscles of the vascular walls. In accordance with the recommendations of the European Society of Cardiology, the main indication for drug use is the treatment of acute decompensated chronic heart failure. Since the first use of the drug (15 years ago), a number of additional, pleiotropic effects have been discovered, which not only affect the myocardium (ischemia and remodeling), but might potentiate organoprotective processes “outside” of the cardiovascular system. The experimental and clinical studies have allowed to identify some positive mechanisms beneficially influencing the function of the lungs, kidneys, liver, gastrointestinal tract, central nervous system, as well as the sepsis and inflammation processes. This paper summarizes the existing research and evidence of pleiotropic effects of levosimendan and outlines some potential new areas of its clinical application.