Effects of single and intermittent levosimendan infusion on left ventricular performance, biomarkers and neurohormonal activation in patients with acute exacerbation of advanced heart failure

Aim: The aim of the study was to investigate the effects of single and intermittent levosimendan infusion on left ventricular performance, biomarkers and neurohormonal activation in patients with acute exerbation of advanced heart failure.Methods: Twenty nine patients (20 male, 9 female, mean age 60,2 ± 7,4 years) with acute exerbation of advanced heart failure (ejection fraction ? 35 %) were included in this study. Levosimendan was initiated as a bolus of 6 ?g/kg followed by a continuous infusion of 0,1 ?g/kg/min for 24 hours in both groups who were taken intravenous single and intermittent (baseline, 1. and 3. month) treatment. Physical examination, echocardiography and biochemical tests (brain natriuretic peptide interleukin-1ß, interleukin-2, interleukin-6, tumour necrosis factor-?) were performed before treatment and on the 3. day of the treatment. The last evaluation was performed on the 6. month after the baseline treatment.Results: A significant improvement in New York Heart Association (NYHA) functional status was detected only in the intermittent levosimendan treated patients on the 6. month compared to the pretreatment status (p<0,001). In addition, there was a significant decrease in left atrial and left ventricular end-systolic and end-diastolic dimensions and volumes (p<0,05). A significant increase in left ventricular ejection fraction (p<0,001) and a significant decrease in myocardial performance index (p<0,045) were detected on the 6. month only in the intermittent levosimendan treated patients. A significant decrease of brain natriuretic peptide (p<0,01) and plasma interleukin-6 (p=0,05) levels were also only obtained in patients who were given intermittent levosimendan.Conclusion: Our study showed that intermittent levosimendan treatment is more effective compared to the single dose levosimendan treatment in improving clinical status, hemodynamic and laboratory parameters in patients with acute exacerbation of advanced heart failure.