Effects of Levosimendan in Advanced HFrEF

This was a single-center, retrospective cohort study. The subjects comprised 63 patients with advanced heart failure in our Heart Failure Center from Nov 2017 to Dec 2020. Inclusion criteria: Left ventricle ejection fraction (LVEF) of <40% (measured with Simpson of Doppler Echocardiography); the definition of advanced heart failure with reduced ejection fraction (HFrEF, LVEF<40%). Exclusion criteria: (1) Symptomatic hypotension or blood pressure (BP) <85/60 mmHg; (2) Severe arrhythmia; (3) Severe infection and respiratory diseases; (4) Allergy to levosimendan or unable to tolerate long-term intravenous pumping treatment. The Estimated glomerular filtration rate (eGFR) is calculated following formula: male, Ccr = (140-age)*weight (kg)*1.23/Scr (μmol/L) (Ccr, Creatinine Clearance Rate; Scr, Serum creatinine; female); Ccr = (140-age)*weight (kg)*1.03/Scr (μmol/L). AF atrial fibrillation group (n = 29) based on ECG heart rhythm data. Two groups of patients with advanced heart failure received conventional treatment recommended by the guidelines, including diuretics, renin-angiotensin system (RAS) blockers, angiotensin receptor-neprilysin inhibitor (ARNI), aldosterone receptor antagonists, β-receptor blockers, digoxin, etc. Levosimendan was administered in accordance with our center’s approved treatment protocol (7 (link)) (the total dose was 12.5 mg, 0.05 ~ 0.2 μg kg⁻¹ min⁻¹, intravenous 24–48 h, repeated infusion every 2–4 weeks for 3 months). Levosimendan infusion was started at a rate of 0.1 μg kg⁻¹·min⁻¹ during the first hour and increased to 0.2 μg·kg⁻¹·min⁻¹ after that if well tolerated in the case of low systolic blood pressure (SBP) (<90 mmHg). Without applying a beginning bolus, levosimendan was infused via a 24 h lasting infusion (0.1 ug/kg/min) while being monitored for hemodynamic effects in an intermittent care scenario. We measured the levels of B-type natriuretic peptide (BNP) before and 3 days after the infusion. The patients will repeat the blood test with a total observation time of 6 months to assess the blood pressure, resting heart rate, body weight, NYHA classification, Creatinine (Crea), eGFR, LVEF, left ventricular end diastolic diameter (LVEDD) and BNP. Then proceed to investigate the differences between the two groups (as shown in Figure 1).