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Levosimendan and main molecular targets. Levosimendan sensitizes cTnC to Ca2+ binding, inhibits PDE 3 and activates K-ATP channels. The cumulative effect consists of improvement in myocardial contractility and reduction in left ventricular filling pressure and coronary, pulmonary and systemic perfusion, without increasing the myocardial oxygen consumption. cTnC: cardiac troponin C; PDE 3: phosphodiesterase 3; K-ATP: ATP-dependent K+ channels; cAMP: cyclic adenosine monophosphate.
