Intermittent levosimendan treatment in patients with severe congestive heart failure
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Levosimendan (LS) is a novel inodilator for the treatment of severe congestive heart failure (CHF). In this study, we investigated the potential long-term effects of intermittent LS treatment on the pathophysiology of heart failure.
Thirteen patients with modest to severe CHF received three 24-h intravenous infusions of LS at 3-week intervals. Exercise capacity was determined by bicycle ergospirometry, well-being assessed by Minnesota Living with Heart Failure Questionnaire (MLHFQ) and laboratory parameters of interest measured before and after each treatment.
One patient experienced non-sustained periods of ventricular tachycardia (VT) during the first infusion and had to discontinue the study. Otherwise the LS infusions were well tolerated. Exercise capacity (VO2max) did not improve significantly during the study although symptoms decreased (P < 0.0001). Levels of plasma NT-proANP, NT-proBNP and NT-proXNP decreased 30–50 % during each infusion (P < 0.001 for all), but the changes disappeared within 3 weeks. Although norepinephrine (NE) appeared to increase during the first treatment (P = 0.019), no long-term changes were observed.
Intermittent LS treatments decreased effectively and repetitively plasma vasoactive peptide levels, but no carryover effects were observed. Patients’ symptoms decreased for the whole study period although there was no objective improvement of their exercise capacity. The prognostic significance of these effects needs to be further studied.
KeywordsLevosimendan Repeated treatment Heart failure Quality of life
We wish to express our thanks to our study nurse, Ms Satu Nenonen, for her valuable assistance throughout the study. This study was supported by grants from the Finnish Foundation for Cardiovascular Research, Ida Montin Foundation, Koskelo Foundation, Paavo Nurmi Foundation, the Finnish Cultural Foundation, North Savo Regional fund and the research funds of Kuopio University Hospital, Finland.
Conflict of interest
Matti Kivikko is an employee of Orion Pharma. On behalf of all other authors, the corresponding author states that there is no conflict of interest.
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