title: Intermittent levosimendan infusions in advanced heart failure:  favourable effects on left ventricular function, neurohormonal balance, and one-year survival.
abstract: The role of repeated infusions of Levosimendan (LEVO) in patients with chronic advanced heart failure is still unclear. Thirty-three patients with chronic heart failure presenting clinical deterioration were randomized 2:1 to receive monthly infusions of LEVO (n = 22) or Furosemide (Controls, n = 11). At the first drug's administration, noninvasive hemodynamic evaluation was performed; before and after each infusion, we assessed NYHA class, systolic and diastolic function, functional mitral regurgitation, and brain natriuretic peptide (BNP) levels. Noninvasive hemodynamic in the LEVO group showed vasodilation and decrease in thoracic conductance (index of pulmonary congestion), whereas in Controls, only a reduced thoracic conductance was observed. In the LEVO group, systolic and diastolic function, ventricular volumes, severity of mitral regurgitation, and BNP levels improved over time from baseline and persisted 4 weeks after the last infusion (P < 0.01). In Controls, no change developed over time in cardiac function and BNP levels. In LEVO-treated patients, 1-year mortality tended to be lower than in those treated with Furosemide. In conclusion, serial LEVO infusions in advanced heart failure improved ventricular performance and favorably modulated neurohormonal activation. Multicenter randomized studies are warranted to test the effect of LEVO on long-term outcome.
authors.affiliation: Divisione di Cardiologia, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milano, Italy. malfi@auxologico.it
authors.forename: Gabriella
authors.initials: G
authors.lastname: Malfatto
authors.forename: Francesco
authors.initials: F
authors.lastname: Della Rosa
authors.forename: Alessandra
authors.initials: A
authors.lastname: Villani
authors.forename: Valeria
authors.initials: V
authors.lastname: Rella
authors.forename: Giovanna
authors.initials: G
authors.lastname: Branzi
authors.forename: Mario
authors.initials: M
authors.lastname: Facchini
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Parati
mesh_terms: D000368:Aged; D002118:Calcium / Q000378:metabolism; D002908:Chronic Disease; D003627:Data Interpretation, Statistical; D004232:Diuretics / Q000008:administration & dosage / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D005665:Furosemide / Q000008:administration & dosage / Q000627:therapeutic use; D006333:Heart Failure / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality / Q000503:physiopathology; D006334:Heart Function Tests; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D008297:Male; D009026:Mortality / Q000639:trends; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011724:Pyridazines / Q000008:administration & dosage / Q000627:therapeutic use*; D012720:Severity of Illness Index; D000077464:Simendan; D016896:Treatment Outcome; D016276:Ventricular Function / Q000187:drug effects* / Q000502:physiology
chemical_list: D004232:Diuretics; D006835:Hydrazones; D011724:Pyridazines; D020097:Natriuretic Peptide, Brain; D000077464:Simendan; D005665:Furosemide; D002118:Calcium