Duration of the beneficial effects of levosimendan in decompensated heart failure as measured by echocardiographic indices and B-type natriuretic peptide

Abstract

Levosimendan is effective in the treatment of decompensated heart failure. The beneficial effects of a single dose of levosimendan last much longer than those of other inotropes. However, the exact duration of the beneficial effects is unknown. We prospectively determined the duration of the cardiac effects, as measured by echocardiography, of levosimendan (LS) following a 24-hour infusion regimen in patients with decompensated heart failure (DHF). The effects of LS on plasma B-type natriuretic peptide (BNP) were also examined. Twenty patients with DHF displaying (1) deteriorating symptoms despite optimal oral therapy, (2) left ventricular ejection fractions (LVEF) < 35%, and (3) cardiac indices of < 2.5 L/m/min received 24 hours of LS infusion. Echocardiography and BNP measurements were performed pre- and postinfusion and were reassessed on days 7, 30, and 90. Left ventricular systolic function indices (cardiac output and LVEF), LV filling pressure indices, and right ventricular systolic function indices all improved following LS treatment. Most of these improvements were sustained for at least 7 days (P < 0.05) and returned to baseline by day 30 postinfusion and remained so on day 90. Plasma BNP also displayed the same pattern of transient improvements. In conclusion, LS transiently improved the cardiac function, and the effects lasted for at least 7 days after discontinuation of infusion. Most effects, except LVEF, were not significantly different from baseline on day 30.