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Failure","grobid_abstract":"Aims Levosimendan improves haemodynamics in acute decompensated heart failure (HF). However, it is increasingly used for repetitive or intermittent infusions in advanced but stable chronic HF, without clear indication, selection criteria, or effect. We tested the hypotheses that (1) levosimendan improves haemodynamics in stable chronic HF and (2) that the response is dependent on baseline clinical and haemodynamic factors. Methods and results Twenty-three patients [median age 56 (49-64) years, four (17%) women] with stable New York Heart Association (NYHA) III and IV HF received a single 24 h levosimendan infusion. Non-invasive haemodynamics (inert gas re-breathing technique), estimated glomerular filtration rate, and N-terminal pro-brain natriuretic peptide were assessed before and after infusion. Levosimendan had the following effects (median change): a significant increase in cardiac output (+9.8 ± 21.6%; P = 0.026) and decrease in N-terminal pro-brain natriuretic peptide (À28.1 ± 16.3%, P \u003c 0.001), estimated total peripheral resistance (À16.9 ± 18.3%, P = 0.005), and mean arterial pressure (À5.9 ± 8.2%, P = 0.007), but no change in estimated glomerular filtration rate (+0.89 ± 14.0%, P = 0.955). There were no significant associations between baseline clinical and/or haemodynamic factors and the levosimendan effect on cardiac output. Conclusions Levosimendan was associated with improved haemodynamics in patients with stable chronic HF, but we could not identify any predictors of the magnitude of haemodynamic response.","publication_date":"2018,,","publication_name":"ESC Heart Failure","grobid_abstract_attachment_id":"84580363"},"document_type":"paper","pre_hit_view_count_baseline":null,"quality":"high","language":"en","title":"Haemodynamic effects of levosimendan in advanced but stable chronic heart failure","broadcastable":false,"draft":null,"has_indexable_attachment":true,"indexable":true}}["work"]; window.loswp.workCoauthors = [43032335]; window.loswp.locale = "en"; window.loswp.countryCode = "SG"; window.loswp.cwvAbTestBucket = ""; window.loswp.designVariant = "ds_vanilla"; window.loswp.fullPageMobileSutdModalVariant = "full_page_mobile_sutd_modal"; window.loswp.useOptimizedScribd4genScript = false; window.loswp.appleClientId = 'edu.academia.applesignon';</script><script defer="" 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data-login_uri="https://www.academia.edu/registrations/google_one_tap" data-moment_callback="onGoogleOneTapEvent" id="g_id_onload"></div><div class="ds-top-related-works--grid-container"><div class="ds-related-content--container ds-top-related-works--container"><h2 class="ds-related-content--heading">Related papers</h2><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="0" data-entity-id="18435718" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/18435718/Prognostic_value_of_noninvasive_hemodynamic_evaluation_of_the_acute_effect_of_levosimendan_in_advanced_heart_failure">Prognostic value of noninvasive hemodynamic evaluation of the acute effect of levosimendan in advanced heart failure</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="38443225" href="https://independent.academia.edu/VillaniAlessandra">Alessandra Villani</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Journal of Cardiovascular Medicine, 2014</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Prognostic value of noninvasive hemodynamic evaluation of the acute effect of levosimendan in advanced heart failure","attachmentId":40062603,"attachmentType":"pdf","work_url":"https://www.academia.edu/18435718/Prognostic_value_of_noninvasive_hemodynamic_evaluation_of_the_acute_effect_of_levosimendan_in_advanced_heart_failure","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/18435718/Prognostic_value_of_noninvasive_hemodynamic_evaluation_of_the_acute_effect_of_levosimendan_in_advanced_heart_failure"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="1" data-entity-id="35745080" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/35745080/Heart_Failure_Hemodynamic_and_Neurohumoral_Effects_of_Continuous_Infusion_of_Levosimendan_in_Patients_With_Congestive_Heart_Failure">Heart Failure Hemodynamic and Neurohumoral Effects of Continuous Infusion of Levosimendan in Patients With Congestive Heart Failure</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="75303479" href="https://independent.academia.edu/RaymundoFlores7">Raymundo Flores</a></div><p class="ds-related-work--abstract ds2-5-body-sm">OBJECTIVES We sought to define the therapeutic dose range of levosimendan in patients with New York Heart Association class II-IV heart failure of ischemic origin. BACKGROUND Levosimendan is a calcium sensitizer for treatment of acute decompensated heart failure. METHODS A double-blind, placebo-controlled, randomized, multicenter, parallel-group study included 151 adult patients. Levosimendan was given as a 10-min intravenous bolus of 3, 6, 12, 24 or 36 g/kg, followed by a 24-h infusion of 0.05, 0.1, 0.2, 0.4 or 0.6 g/kg/min, respectively. Dobutamine, for comparative purposes, was given as an open-label infusion (6 g/kg/min). The primary efficacy variable was the proportion of patients achieving in each treatment group at least one of the following: 1) a 15% increase in stroke volume (SV) at 23 h to 24 h; 2) a 25% decrease in pulmonary capillary wedge pressure (PCWP) (and 4 mm Hg) at 23 h to 24 h; 3) a 40% increase in cardiac output (CO) (with change in heart rate [HR] 20%); 4) a 50% decrease in PCWP during two consecutive measurements. RESULTS The response rate to levosimendan ranged from 50% at the lowest dose to 88% at the highest dose (compared with placebo 14%, dobutamine 70%). A dose-response relationship was demonstrated for levosimendan on increases in CO and SV, and reductions in PCWP during the infusion (for all, p 0.001). Headache (9%), nausea (5%) and hypotension (5%) were the most frequently reported adverse events at higher dosages. CONCLUSIONS Dosing of levosimendan with a 10-min bolus of 6 to 24 g/kg followed by an infusion of 0.05 to 0.2 g/kg/min is well tolerated and leads to favorable hemodynamic effects. 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