Levosimendan: Molecular mechanisms and clinical implications Consensus of experts on the mechanisms of action of levosimendan

Research output: Contribution to journalReview article


The molecular background of the Ca2+-sensitizing effect of levosimendan relates to its specific interaction with the Ca2+-sensor troponin C molecule in the cardiac myofilaments. Over the years, significant preclinical and clinical evidence has accumulated and revealed a variety of beneficial pleiotropic effects of levosimendan and of its long-lived metabolite, OR-1896. First of all, activation of ATP-sensitive sarcolemmal K+ channels of smooth muscle cells appears as a powerful vasodilator mechanism. Additionally, activation of ATP-sensitive K+ channels in the mitochondria potentially extends the range of cellular actions towards the modulation of mitochondrial ATP production and implicates a pharmacological mechanism for cardioprotection. Finally, it has become evident, that levosimendan possesses an isoform-selective phosphodiesterase-inhibitory effect. Interpretation of the complex mechanism of levosimendan action requires that all potential pharmacological interactions are analyzed carefully in the framework of the currently available evidence. These data indicate that the cardiovascular effects of levosimendan are exerted via more than an isolated drug-receptor interaction, and involve favorable energetic and neurohormonal changes that are unique in comparison to other types of inodilators. (C) 2011 Elsevier Ireland Ltd. All rights reserved.


  • Zoltan Papp
  • Istvan Edes
  • Sonja Fruhwald
  • Stefan G. De Hert
  • Markku Salmenpera
  • Heli Leppikangas
  • Alexandre Mebazaa
  • Giovanni Landoni
  • Elena Grossini
  • Philippe Caimmi
  • Andrea Morelli
  • Fabio Guarracino
  • Robert H. G. Schwinger
  • Sven Meyer
  • Bernt Gerhard Wikstrom
  • Kirsten Jorgensen
  • Gerasimos Filippatos
  • John T. Parissis
  • Martin J. Garcia Gonzalez
  • Alexander Parkhomenko
  • Mehmet Birhan Yilmaz
  • Matti Kivikko
  • Piero Pollesello
  • Ferenc Follath
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cardiac and Cardiovascular Systems


  • Levosimendan, Mechanism of action, Ca2+-sensitization, Positive, inotropy, Vasodilation, Cardioprotection
Original languageEnglish
Pages (from-to)82-87
JournalInternational Journal of Cardiology
Issue number2
Publication statusPublished - 2012
Publication categoryResearch