OR-1896 increases force of contraction in the isolated human atrium

Abstract OR-1896 ((R)-N-(4-(4-methyl-6-oxo-1,4,5,6-tetrahydropyridazin-3-yl) phenyl)-acetamide) is the main active metabolite of levosimendan. However, nobody has reported a positive inotropic effect of OR-1896 in isolated human cardiac preparations. The mechanism of action of OR-1896 remains controversial. Hence, we wanted to know whether OR-1896 exerts a positive inotropic effect in humans and what might be the underlying mechanism. Therefore, we measured the contractile effects of OR-1896 (0.01–10 µM cumulatively applied) in isolated electrically stimulated (1 Hz) human right atrial preparations (HAP), obtained during cardiac surgery. OR-1896 given alone exerted time- and concentration-dependent positive inotropic effects. 1 µM OR-1896 increased force by 72 ± 14.7% (p < 0.05, n = 6) and shortened the time of relaxation by 10.6 ± 3.6% (p < 0.05, n = 11) in HAP started at 0.1 µM, plateaued at 1 µM OR-1896 and was antagonized by 1 µM propranolol. The maximum positive inotropic effect of OR-1896 in human right atrial preparations was than that of 10 µM isoprenaline. EMD 57033 (10 µM), a calcium sensitizer, increased force of contraction further in the additional presence of 1 µM OR-1896 by 109 ± 19% (p < 0.05, n = 4). Cilostamide (10 µM), an inhibitor of phosphodiesterase III given before OR-1896 (1 µM) blocked the positive inotropic effect of OR-1896 in HAP. Our data suggest that OR-1896 is indeed a positive inotropic agent in the human heart. OR-1896 acts as a PDE III - inhibitor and OR-1896 is unlikely to act as a calcium sensitizer in the human heart.