A study recently published in Frontiers in Medicine found that levosimendan successfully increased survival in patients diagnosed with pulmonary artery hypertension (PAH) complicated with acute decompensated right heart failure (RHF).

The retrospective study conducted by Qu et al included 87 patients with connective tissue disease-associated PAH (CTD-PAH) that presented with one of the frequent complications of this disease, decompensated RHF. All patients were admitted to the cardiac care unit and were divided into 2 groups, the control group and the levosimendan group, with 41 and 46 patients respectively. During hospitalization, mortality was almost 30% among control patients vs the levosimendan group, with less than 10% of patients dying.

Patients treated with levosimendan showed lower plasma levels of white blood cells, C-reactive protein, troponin I, creatinine, and N-terminal-pro-brain natriuretic peptide, with higher oxygen saturation of mixed venous blood (SvO2), estimated glomerular filtration rate, urine output in 24 hours, and tricuspid annular plane systolic excursion, when compared to the control group. Of these, troponin I and SvO2 were independently associated with mortality. Right ventricle diameter, assessed by echocardiography, was also consistently smaller in the levosimendan cohort vs the control cohort.

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On the other hand, there were no significant differences at the 6-month check-up between the levosimendan and control groups. “Our data demonstrated that levosimendan could improve clinical indices and survival rates during hospitalization, but had no significant effect on medium-and long-term outcomes at follow-up.” the authors noted.

CTD is a known risk factor for developing PAH, associated with a low survival rate, mainly due to complications such as RHF. A decompensated RHF constitutes a true medical emergency with an extremely poor prognosis for short-term survival regardless of effectively initiating treatment with current options.

Levosimendan can be cardioprotective and generate inotropism by calcium-sensitizing myocardiocytes while also dilating blood vessels, hence its current use in left heart failure; nonetheless, studies demonstrated higher inotropic impact in the right ventricle, compared to the left.

“Our results show that levosimendan treatment is practicable and enhances hemodynamic parameters during hospitalization in individuals with decompensated RHF,“ the authors wrote. “The increase in the right ventricular stroke index, as well as the leftward shift of the association between the right ventricular preload and cardiac output, illustrated that the surge in the contractility of the right ventricle instead of the reduction of the afterload is the key underlying mechanism.”

This publication’s theoretical bases and impactful findings suggest that treating RHF with levosimendan in patients with PAH may be beneficial for accurately resolving the emergency through the suspected physiological mechanisms.


Qu C, Feng W, Zhao Q, et al. Effect of levosimendan on acute decompensated right heart failure in patients with connective tissue disease-associated pulmonary arterial hypertension. Front Med (Lausanne). Published online March 04, 2022. doi:10.3389/fmed.2022.778620