The „low-flow“ states related to heart failure need the inotropic haemodynamic support. Increasing myocardial contractility with catecholamines and PDE-inhibitors is associated with excessive intracellular calcium concentration. This side effect can induce life-threatening arrhytmias and increases myocardial oxygen consumption in cardiomyocytes. Calcium sensitization is a relatively new concept of inotropic support. The principle is improving of myocardial performance by direct binding to troponin C without risk of excessive intracellular calcium concentrations. Levosimendan is a calcium sensitizer with dual mode of action. Calcium sensitization and ATP-dependent potassium channels opening are two determinants of its effect. Levosimendan increases contractility, improves diastolic function and its influence to myocardial oxygen consumption is minimal.This reviewarticle presents the mostimportant studies of the use of levosimendan in the conditions of acute heart failure, cardiogenic shock and cardiac surgery. The data were obtained from the medical databases Medline, ScienceDirect and MDConsult in the 1995–2004 period.

        Key words: levosimendan – acute heart failure – cardiogenic shock – cardiac surgery