title: Intermittent levosimendan treatment in patients with severe congestive heart failure.
abstract: OBJECTIVE
  Levosimendan (LS) is a novel inodilator for the treatment of severe congestive heart failure (CHF). In this study, we investigated the potential long-term effects of intermittent LS treatment on the pathophysiology of heart failure.
  
  
  METHODS
  Thirteen patients with modest to severe CHF received three 24-h intravenous infusions of LS at 3-week intervals. Exercise capacity was determined by bicycle ergospirometry, well-being assessed by Minnesota Living with Heart Failure Questionnaire (MLHFQ) and laboratory parameters of interest measured before and after each treatment.
  
  
  RESULTS
  One patient experienced non-sustained periods of ventricular tachycardia (VT) during the first infusion and had to discontinue the study. Otherwise the LS infusions were well tolerated. Exercise capacity (VO2max) did not improve significantly during the study although symptoms decreased (P < 0.0001). Levels of plasma NT-proANP, NT-proBNP and NT-proXNP decreased 30-50% during each infusion (P < 0.001 for all), but the changes disappeared within 3 weeks. Although norepinephrine (NE) appeared to increase during the first treatment (P = 0.019), no long-term changes were observed.
  
  
  CONCLUSIONS
  Intermittent LS treatments decreased effectively and repetitively plasma vasoactive peptide levels, but no carryover effects were observed. Patients' symptoms decreased for the whole study period although there was no objective improvement of their exercise capacity. The prognostic significance of these effects needs to be further studied.
authors.affiliation: Department of Internal Medicine, Kuopio University Hospital and University of Eastern Finland, PO Box 1627, 70211 Kuopio, Finland. Petri.Tuomainen@uef.fi
authors.forename: Petri O
authors.initials: PO
authors.lastname: Tuomainen
authors.forename: Jarkko
authors.initials: J
authors.lastname: Magga
authors.forename: Pekka
authors.initials: P
authors.lastname: Timonen
authors.forename: Kati
authors.initials: K
authors.lastname: Miettinen
authors.forename: Minna
authors.initials: M
authors.lastname: Kurttila
authors.forename: Esko
authors.initials: E
authors.lastname: Vanninen
authors.forename: Tomi
authors.initials: T
authors.lastname: Laitinen
authors.forename: Kirsi
authors.initials: K
authors.lastname: Timonen
authors.forename: Kari
authors.initials: K
authors.lastname: Punnonen
authors.forename: Ilkka
authors.initials: I
authors.lastname: Parviainen
authors.forename: Ari
authors.initials: A
authors.lastname: Uusaro
authors.forename: Olli
authors.initials: O
authors.lastname: Vuolteenaho
authors.forename: Matti
authors.initials: M
authors.lastname: Kivikko
authors.forename: Keijo
authors.initials: K
authors.lastname: Peuhkurinen
mesh_terms: D000368:Aged; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005080:Exercise Test; D017079:Exercise Tolerance / Q000187:drug effects*; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism; D011724:Pyridazines / Q000008:administration & dosage / Q000627:therapeutic use*; D012720:Severity of Illness Index; D000077464:Simendan; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan; D010100:Oxygen