Intermittent Levosimendan Infusion in Ambulatory Patients with End-Stage Heart Failure: A Systematic Review and Meta-Analysis

Purpose The safety and efficacy of ambulatory intermittent LEVO infusions in patients with end-stage HF are yet not established. We sought to synthesize the available evidence regarding safety and efficacy of intermittent Levosimendan (LEVO) infusions in ambulatory patients with end-stage heart failure (HF). Methods We systematically searched MEDLINE, EMBASE, SCOPUS, Web of Science and Cochrane databases, from inception to September 27,2019 for studies reporting outcome of adult ambulatory patients with end-stage HF treated with intermittent LEVO infusion. Results Fifteen studies (8 randomized and 7 observational), comprised 984 patients (LEVO[N=727] and controls[N=257]) met the inclusion criteria. LEVO was associated with improved New York Heart Association(NYHA) functional class, (weighted mean difference [WMD] -1.04, 95%CI -1.70 to -0.38, p Conclusion Intermittent Levosimendan infusions in ambulatory patients with end-stage HF is associated with less frequent cardiovascular death alongside with improved NYHA class, quality of life, BNP levels and LV function. However, the current evidence is limited by heterogeneous and relatively small studies.