Levosimendan in the treatment of AHF: Lessons from surveys and clinical trials

Alexandre Mebazaa, Juan F. Delgado, Fatima Franco, Wolfgang Toller, John Parissis, Daniela Pini, George Giannakoulas, Vojka Gorjup, Peter C J Karpati, Ferenc Follath, Markku S. Nieminen

Research output: Contribution to journalArticlepeer-review


Acute heart failure (AHF) is a primary cause of hospital admission throughout the world. Several acute heart failure registries have been conducted in the United States (U.S.) and Europe assessing the clinical presentation of AHF in the real world. Of the five large registries two were conducted in the U.S. are: the Acute Decompensated Heart Failure National Registry (ADHERE) [1], and Organized Program to Initiate Life Saving Treatment in Patients Hospitalized for Heart Failure (OPTIMIZE-HF) [2]. The other three are European registries: the EuroHeart Failure Survey (EHFS I and II) [3-5], the Italian Survey [6] and in France the Epidémiologie Francaise de l'Insuffisance Cardiaque Aiguë (EFICA; French Epidemiology of Acute Heart Failure) [7]. These registries have described the clinical profile, the underlying pathophysiology, the relevant therapeutic interventions used in routine clinical practice, and short-and/or long term outcomes of AHF patients. However, the percentage of patients who received levosimendan in these surveys was very small in order to have valid data about the impact of this therapeutic approach on patients' clinical course and prognosis. In contrast, at least four randomized clinical trials (LIDO, RUSSLAN, REVIVE-II, SURVIVE) have assessed the safety and efficacy of levosimendan, providing clarification on important aspects of whether and through what means levosimendan improves short-and long term outcome of patients suffering from AHF. Levosimendan has also rapidly and significantly reduced Brain natriuretic peptide (BNP) levels in several studies, indicating a hemodynamic response. Therefore, serial measurements of B-type natriuretic peptides (BNP, NT-proBNP) may be a valuable tool in every day clinical practice in order to identify responders to levosimendan treatment and to optimize the overall treatment in AHF, predicting also future adverse clinical outcomes. However, this hypothesis should be further tested in randomized trials in a similar way to that examined in patients with chronic heart failure.

Original languageEnglish
Pages (from-to)228-233
Number of pages6
JournalEuropean Journal of Heart Failure, Supplement
Issue numberSUPPL. 2
Publication statusPublished - Jun 2008

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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