A pre - post study to evaluate the clinical efficacy of levosimendan infusion in acute decompensated heart failure

Background: Heart failure with reduced ejection fraction is a prevalent condition associated with high mortality rates. Levosimendan, a calcium sensitizer and inodilator, has emerged as a promising agent for improving cardiac contractility. Aims and Objectives: The study aims to evaluate the clinical efficacy of 24-hour levosimendan infusion in acute decompensated HFrEF patients requiring inotropic support by comparing the pre and post ejection fraction and its effect on renal function testsand serum electrolytes. Materials and methods: It was a pre-post study conducted in Shifaa Hospital, Bangalore over 12 months among 50 HFrEF patients. After a baseline echo and blood test, Levosimendan was loaded at 12µg/kg over 10 min followed byinfusion of 0.1µg/kg/min for 24 hours; subsequentlyby a 2D-echo. Results: The mean pre-infusion EF was 31.49% and post-infusion EF was 34.16% and this improvement was found to be statistically significant (p<0.001). Among 50 patients, 86% had improvement in EF ranging from 0.13–10.7%. Out of which 32% had 0.1-2%, while 24%had 2-4% improvement in EF. There was a significant reduction in eGFR in 64% (p<0.001) but the serum electrolyte levels did not show any significant changes (p>0.05). Conclusions: There is a significant improvement in ejection fraction post levosimendan, but a significant reduction in eGFR with no significant effect on the serum sodium or potassium levels.