Prognostic value of noninvasive hemodynamic evaluation of the acute effect of levosimendan in advanced heart failure

Gabriella Malfatto, Francesco Della Rosa, Valeria Rella, Alessandra Villani, Giovanna Branzi, Simonetta Blengino, Alessia Giglio, Mario Facchini, Gianfranco Parati

Research output: Contribution to journalArticlepeer-review


AIMS: Optimization of inotropic treatment in worsening heart failure sometimes requires invasive hemodynamic assessment in selected patients. Impedance cardiography (ICG) may be useful for a noninvasive hemodynamic evaluation. METHODS: ICG was performed in 40 patients (698 years; left ventricular ejection fraction 27.55.6%; New York Heart Association 3.180.34; Interagency Registry for Mechanically Assisted Circulatory Support 5.480.96, before and after infusion of Levosimendan (0.1-0.2μg/kg per min for up to 24h). Echocardiogram, ICG [measuring cardiac index (CI), total peripheral resistances (TPRs) and thoracic fluid content (TFC)] and plasma levels of brain natriuretic peptide (BNP) were obtained; in nine patients, right heart catheterization was also carried out. RESULTS: When right catheterization and ICG were performed simultaneously, a significant relationship was observed between values of CI and TPR, and between TFC and pulmonary wedge pressure. ICG detected the Levosimendan-induced recovery of the hemodynamic status, associated with improved systolic and diastolic function and reduction in BNP levels. One-year mortality was 4.4%. At multivariate analysis, independent predictors of mortality were: no improvement in the severity of mitral regurgitation, a persistent restrictive filling pattern (E/E'>15), a reduction of BNP levels below 30% and a change below 10% in CI, TPR and TFC. When combined, absence of hemodynamic improvement at ICG could predict 1-year mortality with better sensitivity (86%) and specificity (85%) than the combination of echocardiographic and BNP criteria only (sensitivity 80% and specificity 36%). CONCLUSION: Noninvasive hemodynamic evaluation of heart failure patients during infusion of inodilator drugs is reliable and may help in their prognostic stratification.

Original languageEnglish
Pages (from-to)322-330
Number of pages9
JournalJournal of Cardiovascular Medicine
Issue number4
Publication statusPublished - 2014


  • advanced heart failure
  • impedance cardiography
  • Levosimendan
  • noninvasive hemodynamic assessment

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)


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