Efficacy of levosimendan for acute decompensated heart failure with preserved ejection fraction in the elderly - a single-center retrospective analysis

Q: What was the study’s main aim regarding levosimendan in acute HFpEF?

To evaluate the effects of levosimendan in elderly patients presenting with acute HFpEF, since guidelines do not address inotropic drug use during acute episodes.

Q: How were patients selected and how were outcomes assessed?

Patients aged ≥65 years hospitalized with acute HFpEF were identified and matched using propensity score matching (PSM). Echocardiographic parameters and BNP were measured before and after levosimendan, and rehospitalization for HF and all-cause mortality were compared during follow-up.

Q: Did levosimendan improve long-term prognosis?

No. After a median follow-up of 12.5 months, composite outcomes of HF rehospitalization and all-cause mortality did not differ significantly between groups.

Sep 28, 2026

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Guidelines recommend medical therapy for heart failure with preserved ejection fraction (HFpEF) but provide limited direction on inotropic drugs during acute episodes. This real-world single-center retrospective analysis evaluated levosimendan effects in elderly patients with acute HFpEF, using propensity score matching (PSM). Echocardiographic indices and BNP were compared before and after treatment, with rehospitalization for HF and all-cause mortality assessed over follow-up.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Abstract

Introduction

HFpEF epidemiology and clinical challenges

Echocardiographic assessment and GLS relevance

Methods

Results

Conclusions

Xu etal. BMC Cardiovascular Disorders (2026) 26:1 BMC Cardiovascular Disorders [https://doi.org/10.1186/s12872-025-05224-3](https://doi.org/10.1186/s12872-025-05224-3) RESEARCH Open Access Efficacy of levosimendan for acute decompensated heart failure with preserved ejection fraction in the elderly: a single-center retrospective analysis Xiaohong Xu 1†, Fangchao Lv 1†, Chenkai Xu 1† and Xiuxiu Lai2*† Abstract Aims Current guidelines recommend medical treatment for heart failure with preserved ejection fraction (HFpEF) but do not address inotropic drug use during acute HF episodes. This real-world study aimed to evaluate the effects of levosimendan in elderly patients presenting with acute HFpEF. Methods We retrospectively identified patients aged ≥ 65 years hospitalized with acute HFpEF at our institution. Using propensity score matching (PSM), 160 patients were selected. Echocardiographic parameters and B-type natriuretic peptide (BNP) levels were assessed before and after levosimendan administration. Rehospitalization for heart failure (HF) and all-cause mortality were compared during follow-up. Results Multivariable analysis revealed significantly greater improvements in the levosimendan group for septal early diastolic mitral inflow velocity to mitral annular tissue velocity ratio (E/e’) (ΔE/e’: -2.4 ± 2.4 vs. -1.9 ± 2. 1; t = -2 . 09, 95% CI: -0.76 to-0 . 02; p = 0 . 038) and New York Heart Association (NYHA) class [median change: -1 (-1 to-0 . 25) vs. -1(-1 to 0); p = 0 . 048] . No significant between-group differences were observed in ΔBNP, Δabsolute global longitudinal strain (ΔaGLS), Δleft ventricular ejection fraction (ΔLVEF), or hospital length of stay. Subgroup analyses demonstrated greater improvements in ΔaGLS and Δseptal E/e’ among patients with baseline aGLS < 16% or septal E/e’ ≥15 . After a median follow-up of 12.5 months, composite outcomes of rehospitalization for HF and all-cause mortality did not differ significantly between groups (levosimendan 21 vs. control 23; Log-rank p = 0 . 095) . Conclusions For older patients with acute HFpEF combined with more comorbidities, although levosimendan may transiently improve hemodynamics and functional capacity in the acute phase, it fails to demonstrate long-term prognostic benefits. The clinical benefit of this drug may be limited to select patients, and its clinical application may lack cost-effectiveness for broader application. †Xiaohong Xu, Fangchao Lv, Chenkai Xu and Xiuxiu Lai these authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. *Correspondence: Xiuxiu Lai [kimmyfj@163.com](kimmyfj@163.com) Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativecommons.org/l](http://creativecommons.org/l)icenses/by/4.0/. Xu et al. BMC Cardiovascular Disorders (2026) 26:1 Page 2 of 13 Keywords Levosimendan, Heart failure with preserved ejection fraction (HFpEF), Echocardiography, Global longitudinal strain (GLS), E/e' ratio Introduction Heart failure with preserved ejection fraction (HFpEF) represents a

FAQs

What was the study’s main aim regarding levosimendan in acute HFpEF?

To evaluate the effects of levosimendan in elderly patients presenting with acute HFpEF, since guidelines do not address inotropic drug use during acute episodes.

How were patients selected and how were outcomes assessed?

Patients aged ≥65 years hospitalized with acute HFpEF were identified and matched using propensity score matching (PSM). Echocardiographic parameters and BNP were measured before and after levosimendan, and rehospitalization for HF and all-cause mortality were compared during follow-up.

Did levosimendan improve long-term prognosis?

No. After a median follow-up of 12.5 months, composite outcomes of HF rehospitalization and all-cause mortality did not differ significantly between groups.

Sep 28, 2026

Uploaded by kopisore