title: Effects of levosimendan on quality of life and emotional stress in advanced heart failure patients.
abstract: OBJECTIVE
  Levosimendan improves central hemodynamics and symptoms in acutely decompensated chronic heart failure (CHF) patients. However, its effects on quality of life, emotional stress and functional capacity of patients with advanced CHF have not been properly investigated.
  
  
  RESULTS
  Sixty-three advanced CHF patients (NYHA III-IV, LVEF<30%) were randomized (2:1) to receive either a 24-h levosimendan infusion of 0.1 mug/kg/min or placebo. Questionnaires addressing quality of life [Kansas City Cardiomyopathy Questionnaire (KCCQ), functional and overall, Duke's Activity Status Index (DASI)] and emotional stress [Zung self-rating depression scale (SDS), Beck Depression Inventory (BDI)], as well as plasma BNP and 6-min walking distance (6MWT as a marker of exercise capacity) were assessed before treatment and at hospital discharge. A significant improvement in NYHA class (2.1 +/- 0.7 from 3.3 +/- 0.7, p < 0.01), 6 MWT (305 +/- 152 from 215 +/- 142 m, p < 0.01) and plasma BNP (598 +/- 398 from 1,078 +/- 756 pg/ml, p < 0.01) was observed post-treatment only in levosimendan-treated group. KCCQ functional (45 +/- 19 from 35 +/- 17%, p < 0.05) and overall (34 +/- 13 from 28 +/- 11%, p < 0.05), DASI (26 +/- 13 from 22 +/- 12, p < 0.05), Zung SDS (38 +/- 12 from 42 +/- 13, p < 0.01) and BDI (11 +/- 6 from 14 +/- 8, p < 0.05) scores also improved in levosimendan-treated patients, while remained unchanged in the placebo group. The hospital length stay was shorter in levosimendan group compared to placebo (3.2 +/- 1.7 versus 5.8 +/- 2.1 days, p < 0.01). Levosimendan-induced BNP reduction was significantly correlated with concomitant increase in 6MWT (r = 0.643, p < 0.001) as well as with the decrease of BDI (r = 0.30, p < 0.05) and Zung SDS (r = 0.25, p = 0.05).
  
  
  CONCLUSIONS
  Levosimendan seems to have a beneficial effect on quality of life, physical activity and emotional stress in advanced CHF patients, reducing concurrently hospitalization length.
authors.affiliation: Second Cardiology Department and Heart Failure Unit, University of Athens Medical School, Attikon University Hospital, Athens, Greece. vasobistola@yahoo.com
authors.forename: John T
authors.initials: JT
authors.lastname: Parissis
authors.forename: Constantinos
authors.initials: C
authors.lastname: Papadopoulos
authors.forename: Maria
authors.initials: M
authors.lastname: Nikolaou
authors.forename: Vassiliki
authors.initials: V
authors.lastname: Bistola
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Farmakis
authors.forename: Ioannis
authors.initials: I
authors.lastname: Paraskevaidis
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Filippatos
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Kremastinos
mesh_terms: D000368:Aged; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D017079:Exercise Tolerance / Q000187:drug effects; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood / Q000187:drug effects; D011594:Psychometrics; D011724:Pyridazines / Q000627:therapeutic use*; D011788:Quality of Life; D000077464:Simendan; D013315:Stress, Psychological / Q000188:drug therapy* / Q000209:etiology; D011795:Surveys and Questionnaires
chemical_list: D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D020097:Natriuretic Peptide, Brain; D000077464:Simendan