The hemodynamic effects of levosimendan in patients with acute heart failure and systolic ventricular dysfunction may influence short-term outcomes. This retrospective cohort study published in the Journal of Cardiovascular Pharmacology assessed whether blood pressure (BP) reductions after a 24-hour levosimendan infusion were associated with in-hospital mortality.
A total of 161 patients hospitalized for acute heart failure between 2017 and 2024 and treated with levosimendan according to a standard protocol were included. During hospitalization, biometric, clinical, laboratory, and echocardiographic parameters were collected. Changes in systolic BP (delta-SBP) and mean arterial pressure (delta-MAP) before and after infusion were analyzed in relation to mortality.

Greater reductions in SBP and MAP were observed among non-survivors compared with survivors (delta-SBP: 21.4±23.6 mmHg vs. 10.1±19.1 mmHg; p=0.023; delta-MAP: 17.8±23.3 mmHg vs. 8.8±15.8 mmHg; p=0.034). Associations were independent of baseline BP values, and most patients maintained post-infusion SBP >90 mmHg. In multivariable analysis, larger SBP reduction independently predicted in-hospital mortality (OR 1.053; 95% CI 1.015-1.092; p=0.006). Lower absolute post-infusion SBP was also independently associated with mortality (OR 0.942; 95% CI 0.896–0.990; p=0.019). When analysis was repeated in patients with post-infusion SBP >90 mmHg, only delta-SBP remained independently associated (OR 1.051; 95% CI 1.009–1.095; p=0.017).

Larger systolic BP reductions after levosimendan were independently associated with in-hospital mortality. Monitoring SBP changes may support risk stratification and clinical decision-making.