Levosimendan Improves Clinical Outcomes of Refractory Heart Failure in Elderly Chinese Patients

BACKGROUND: Levosimendan has been extensively used to treat heart failure (HF) for nearly 10 years, but data on levosimendan used in elderly patients with refractory HF remains limited. This study aimed to investigate the effects of levosimendan on elderly patients with intractable HF.
MATERIAL AND METHODS: A total of 268 patients with HF (over 70 years, New York Heart Association [NYHA] classification III–IV, LVEF ≤40%, plasma NT-proBNP ≥1000 pg/mL) received conventional anti-HF therapies for 2 weeks. Such therapies include the limiting of salt intake, increasing myocardial contractility (without levosimendan), inducing urine, antagonizing aldosterone, antagonizing myocardial remodeling, and, if necessary, using antibiotics. Our study included 42 patients without symptoms whose improvement was re-evaluated and presented in NYHA class III–IV, LVEF ≤40%, plasma NT-proBNP ≥1000.0 pg/mL, and serum creatinine <110.0 µmol/L. These patients were divided into an experimental groups (n=21, treated with levosimendan) and a control group (n=21, continuously given regular treatment as before). After 1 week, 42 patients were assessed for changes in NYHA classification, LVEF, and NT-proBNP.
RESULTS: No severe complications related to levosimendan were noted. Compared with the control group, NYHA classification (I–II: 1 versus 21, III–IV: 20 versus 0, P<0.05) and LVEF (30.62±6.19% versus 45.83±5.06%, P<0.05) were increased, and plasma NT-proBNP was reduced (458.35±193.16 pg/mL versus 2921.52±1395.97 pg/mL, P<0.05) in the experimental group.
CONCLUSIONS: Our study showed levosimendan significantly and safely improved clinical outcomes of refractory heart failure in elderly patients.

Keywords: Anti-Arrhythmia Agents - therapeutic use, Aged, 80 and over, Asian Continental Ancestry Group, China, Creatinine - blood, Heart Failure - physiopathology, Hydrazones - therapeutic use, Natriuretic Peptide, Brain - blood, Peptide Fragments - blood, Prospective Studies, Pyridazines - therapeutic use, Stroke Volume - drug effects