The potential effect of calcium sensitizer in pulmonary hypertension post-coronavirus disease-19 infection in presumptive familial dilated cardiomyopathy: a case report

BACKGROUND: Coronavirus disease-19 infection can exacerbate preexisting chronic heart failure, even after mild illness. This report describes a patient with preexisting dilated cardiomyopathy who developed worsening biventricular failure following recurrent coronavirus disease-19 infections and subsequently improved after intermittent intravenous calcium sensitizer therapy. CASE PRESENTATION: A 37-year-old Indonesian man with advanced heart failure presented with progressive right ventricular dysfunction and worsening pulmonary hypertension after a second mild coronavirus disease-19 infection. Comprehensive phenotyping and risk stratification were performed using multimodality assessment. The patient received intermittent intravenous levosimendan infusion in addition to optimized guideline-directed medical therapy, resulting in marked clinical, hemodynamic, and biomarker improvement. CONCLUSION: Managing advanced heart failure with mixed-type pulmonary hypertension. Following coronavirus disease-19 infection remains a complex clinical challenge. This case contributes to the growing evidence supporting the potential role of levosimendan as adjunctive therapy in managing post-coronavirus disease mixed-type pulmonary hypertension with intractable congestion and biventricular failure.