Repetitive Infusion of Levosimendan in Patients with Chronic Heart Failure: A Meta-Analysis

Source of support: Self financing Background: Repetitive or intermittent levosimendan infusion is gradually becoming more commonly considered for pa-tients with advanced chronic heart failure. However, previous randomized controlled studies (RCTs) reported conflicting results on the effects of levosimendan when administered repetitively. The aim of this meta-analy-sis was to generate up-to-date evidence to assess the effect of levosimendan in this group of patients. Material/Methods: A literature review identified 8 qualified studies. A meta-analysis was performed to assess mortality and left ventricular ejection fraction (LVEF). Results: Use of levosimendan contributed to significantly reduced mortality at the end of mid-term follow-up. The mor-tality rates in levosimendan and control group were 23 of 226 (10.2%) and 53 of 198 (26.8%), respectively (RR: 0.40, 95%CI: 0.26–0.63, P<0.0001). The trend of significantly decreased mortality was observed in levosi-mendan vs. placebo subgroup (RR: 0.28, 95%CI: 0.15–0.54, P=0.0001, I2=0%) but not in levosimendan vs. do-butamine, PGE1, or furosemide subgroup (p=0.19, p=0.64 and p=0.25, respectively). Levosimendan also con-tributed to significantly improved LVEF improvement at the end of follow-up (mean difference: 3.69%, 95CI: 0.92–6.45%, p=0.009). Conclusions: Intermittent or repetitive levosimendan infusion might be a promising strategy to reduce mortality and improv