Haemodynamic Effects of Levosimendan in Outpatients with Advanced Heart Failure: An Echocardiographic Pilot Study.

ABSTRACT Infusions of levosimendan delivered in ambulatory/outpatient settings have been shown to improve quality of life and reduce hospitalizations in patients with advanced heart failure. The aim of this study was to evaluate the effects of ambulatory infusion of levosimendan on echocardiographic markers of perfusion, congestion, and cardiovascular efficiency.Thirty patients with diagnosed advanced HF underwent ambulatorial infusion of levosimendan. Standardized transthoracic echocardiography, Doppler examinations, and strain analysis were performed 1 h before and 48 h after completion of ambulatory infusion of 6,25 mg of levosimendan. At 48 h after ambulatory infusion of levosimendan, a significant increase in the stroke volume (37.47 ± 12.38 mL/beat vs 45.47 ± 14.48 mL/beat; p < 0.05) and cardiac output (2.64 ± 0.66 L/min vs 3.26 ± 0.57 L/min; p < 0.05) occurred. Significant post-versus-pre reductions were also recorded in left atrial pressure (27.37 ± 6.62 mmHg vs 22.82 ± 4.17 mmHg; p < 0.01); mean pulmonary artery pressure (27.69 ± 4.64 mmHg vs 23.24 ± 5.32; p < 0.01); and inferior vena cava diameter (23.81 ± 7.63 mm vs 18.53 ± 4.82 mm; p < 0.01) occurred. Significant improvements were noted in the resting cardiac power output (0.46 ± 0,15watt vs 0.53 ± 0.22 watt; p < 0.01) and the resting cardiac power index (0.24 ± 0.08 watt/m2 vs 0.28 ± 0.11 watt/m2; p < 0.01).In outpatients with advanced HF infusion of levosimendan was associated with hemodynamic responses that may contribute to the clinical benefit previously reported in such patients.