title: Repeated infusions of levosimendan: well tolerated and improves functional capacity in decompensated heart failure - a single-centre experience.
abstract: BACKGROUND
  Levosimendan is a novel agent used in the treatment of patients with decompensated heart failure to enhance cardiac contractility. Recent clinical studies have demonstrated that single doses of levosimendan have positive symptomatic and haemodynamic benefits, few have explored the efficacy and safety of intermittent repeated doses of levosimendan.
  
  
  OBJECTIVE
  In this prospective study we document our single-centre experience of repeated administration of levosimendan to patients with decompensated heart failure.
  
  
  METHODS
  Prospective data were collected and analysed with respect to New York Heart Association (NYHA) class, mean arterial pressure (MAP), brain natriuretic peptide levels (BNP) and adverse events.
  
  
  RESULTS
  Forty-four consecutive patients with decompensated heart failure received repeated doses of levosimendan. The mean dosing interval was 66.2 (12) days. All patients had documented evidence of impaired left ventricular function, with a mean ejection fraction (EF) of 23.7% (2.2). Fifty-eight percent were NYHA class IV, mean age 50 (2.4), 82% were male. A significant drop in BNP levels and improvement in NYHA class was seen post-infusion. In general, levosimendan was well tolerated with 130 (83.5%) infusions completed without an adverse event. Twenty-five percent of patients were bridged to cardiac transplant or left ventricular assist device (LVAD) insertion. Four patients received 12 infusions, in total in the community.
  
  
  CONCLUSIONS
  The majority of repeated levosimendan infusions were well tolerated, reduced BNP and improved NYHA functional class. In selected patients it can be administered in the community. Further investigation is required to assess the efficacy and safety of this approach.
authors.affiliation: Advanced Heart Failure and Cardiac Transplant Service, Royal Perth Hospital, Wellington Street, GPO Box X2213, Perth 6847, Western Australia, Australia. Niki.parle@health.wa.gov.au
authors.forename: N M
authors.initials: NM
authors.lastname: Parle
authors.forename: M D
authors.initials: MD
authors.lastname: Thomas
authors.forename: L
authors.initials: L
authors.lastname: Dembo
authors.forename: M
authors.initials: M
authors.lastname: Best
authors.forename: G O '
authors.initials: GO
authors.lastname: Driscoll
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D002316:Cardiotonic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage* / Q000009:adverse effects; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011446:Prospective Studies; D011724:Pyridazines / Q000008:administration & dosage* / Q000009:adverse effects; D000077464:Simendan
chemical_list: D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D020097:Natriuretic Peptide, Brain; D000077464:Simendan