Clinical and echocardiographic changes after intermittent levosimendan infusion in patients with advanced heart failure

INTRODUCTION: To evaluate the short-term clinical, structural, and functional cardiac changes following intermittent levosimendan infusion and their prognostic implications in patients with advanced heart failure (AdHF). METHODS: In this prospective, multicentre, observational study, patients with AdHF treated with intermittent levosimendan infusion (12.5 mg at a rate of 0.1 μg/kg/min, without a bolus) were enrolled. Clinical, laboratory, and comprehensive echocardiographic assessments were performed at baseline, 48 h, and 30 days post-infusion. The primary endpoint was to evaluate the extent of clinical and cardiac structure and function changes during the first 30 days after levosimendan infusion. Secondary outcome of interest was the association of cardiac changes and a composite endpoint of decompensated HF, urgent HF rehospitalization, cardiogenic shock, cardiac arrest, and cardiovascular death at 6 months. RESULTS: A total of 37 patients with AdHF were included (mean age 71.1 ± 9.0 years; 59.5% male). A non-significant trend reduction in mean arterial pressure values was observed over time (81.3 ± 9.5 mmHg vs 80.9 ± 7.7 mmHg after 48 h vs 79.1 ± 6.9 mmHg at 30 days, P-value for trend = .079). NT-proBNP levels significantly decreased at 48 h and rose again by 30 days [from 1802 (1127-4436) ng/l to 1060 (830-3864) ng/l at 48 h and 1661 (1015-4245) ng/l at 30 days, P-value for trend = .006]. The main left ventricular (LV) and right ventricular (RV) structure and function parameters improved at 48 h but returned to baseline or a slight improvement by 30 days (LV ejection fraction: 30.9 ± 11.3% vs 32.2 ± 11.2%, vs 30.9 ± 11.3%, P-value for trend = .001; LV global longitudinal strain: -8.0 ± 3.5% vs -9.2 ± 3.5% vs -8.0 ± 3.3%, P-value for trend < .001; tricuspid annular plane systolic excursion: 16.9 ± 3.1 mm vs 17.7 ± 3.4 vs 17.0 ± 3.5, P-value for trend .007; systolic pulmonary artery pressure: 48.7 ± 15.8 mmHg vs 41.6 ± 12.7 mmHg vs 46.1 ± 15.0, P-value for trend