title: Effects of levosimendan on heart failure in normotensive patients: does loading dose matter?
abstract: BACKGROUND
  Levosimendan is a calcium sensitizer and K(+)-ATP channel opener with inotropic and vasodilatatory effects irrespective of myocardial oxygen consumption, used for treatment of heart failure (HF). A loading dose is usually given by infusion for 12 h; however, profound lowering of blood pressure often disrupts or prolongs the infusion. The aim of this study was to assess clinical, biochemical and myocardial differences between different regimes of levosimendan therapy, with or without loading dose, and compared to standard therapy in heart failure.
  
  
  METHODS
  Fifty-seven patients (mean age ± SD: 60.9 ± 9.3 years, 45 males) with HF, New York Heart Association (NYHA) III-IV, reduced left ventricular ejection fraction (LVEF) were included. Twenty patients (NB group) were given levosimendan without loading dose, 14 patients (B group) were given levosimendan with loading dose, and 23 patients (C group) were given standard therapy. Clinical, biochemical and echocardiographic characteristics at baseline and one week after treatment were evaluated.
  
  
  RESULTS
  Groups were similar at baseline. After one week NHYA class (P < 0.001), NT pro-BNP (P < 0.001), LVEF (P = 0.045), E/A (P = 0.048) E/e' (P < 0.001), and PAPs (P < 0.001) decreased. DT (P = 0.011) and TAPSE (P = 0.035) increased in all groups.
  
  
  CONCLUSIONS
  Levosimendan, as well as standard therapy, improves myocardial function and symptoms of HF, irrespective of the loading dose administration. Treatment options for patients with end-stage heart failure refractory to conventional medical therapy are limited. Inotropic drugs play an important role in heart failure (HF).
authors: Department of Cardiovascular Diseases, Siena University Hospital , Siena , Italy.
authors: Elisabetta
authors: E
authors: Palmerini
authors: Stefan
authors: S
authors: Söderberg
authors: Sergio
authors: S
authors: Mondillo
authors: Roberto
authors: R
authors: Favilli
authors: Stefano
authors: S
authors: Lunghetti
mesh_terms: D002316:Cardiotonic Agents / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011724:Pyridazines / Q000008:administration & dosage*; D000077464:Simendan; D014463:Ultrasonography; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D002316:Cardiotonic Agents; D006835:Hydrazones; D010446:Peptide Fragments; D011724:Pyridazines; D014665:Vasodilator Agents; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D000077464:Simendan
keywords: Echocardiography; heart failure; natriuretic peptides