title: Use of levosimendan in patients with heart failure in different settings: case reports and treatment guidance.
abstract: BACKGROUND
  The inodilator levosimendan was developed as a treatment for acutely decompensated severe chronic heart failure. In recent years, its use has broadened to treatment of heart failure in different settings. These include advanced chronic heart failure, and other scenarios where haemodynamic stability is sought, such as pre-operative treatment of patients at risk of low cardiac output syndrome or peri-operative heart failure. The aims of this presentation of four case reports were to compare the use of levosimendan in different settings, and to highlight differences and similarities in the effects obtained, with the purpose of defining common guidance on the use of levosimendan.
  
  
  METHODS
  We retrospectively reviewed the records of patients with heart failure in the registries of our wards, identified and described four cases where levosimendan was received in four different settings. We provide here a systematic report on these four cases.
  
  
  RESULTS
  One patient suffered from acutely worsened chronic heart failure, one from advanced chronic heart failure, with repetitive treatment needed, one experienced acute ventricular failure as a result of a perioperative myocardial infarction, and one with left-ventricular function impairment and planned surgery.
  
  
  CONCLUSIONS
  Heart failure arising from different aetiologies and occurring in different settings is amenable to successful treatment with levosimendan.
authors.affiliation: Kardiologimottagning (Hjärta och Kärl), Sabbatsbergs sjukhus, Stockholm, Sweden.
authors.forename: Irina
authors.initials: I
authors.lastname: Barbici
authors.affiliation: Cardiology Clinic, Södersjukhuset (Stockholm South General Hospital), Stockholm, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Hedman
authors.affiliation: Department of Anesthaesiology and Intensive Care, Södersjukhuset (Stockholm South General Hospital), Stockholm, Sweden.
authors.forename: Carl-Arne
authors.initials: CA
authors.lastname: Ewaldsson
keywords: acute heart failure; advanced chronic heart failure; cardiac surgery; levosimendan