Short-Term Effect of Levosimendan in Acute Right Heart Failure Caused by Pulmonary Hypertension: A Pilot Study

Pulmonary hypertension (PH) causes right heart failure (RHF), leading to an unfavorable prognosis. This prospective single-arm study evaluated the acute effects of levosimendan in 105 patients with RHF secondary to PH. Levosimendan was administered as a continuous infusion at a rate of 0.1 μg/kg/min over 24 hours. The primary end point was improvement in WHO Functional Class (WHO-FC) at day 7, with secondary end points including the Borg dyspnea scores, systolic pulmonary artery pressure (SPAP), and echocardiographic parameters. Treatment resulted in significant clinical and hemodynamic improvements by day 7. WHO-FC decreased from a median of 4.00 (3.00, 4.00) to 3.00 (2.00, 3.00) ( P < 0.001) and Borg dyspnea scores improved from 8.00 (6.00, 8.00) to 4.00 (4.00, 5.00) ( P < 0.001). SPAP decreased significantly from 57.51 (51.24, 68.00) mm Hg to 50.16 (44.55, 59.83) mm Hg ( P = 0.002). Echocardiography showed favorable changes, including reduced left ventricular end-systolic volume and tricuspid regurgitation velocity, alongside increased left ventricular fractional shortening. In a subgroup with left heart disease, left ventricular ejection fraction increased from 33.10% (27.58, 47.20) to 36.50% (30.63, 49.50) ( P = 0.025). Patients with heart failure with preserved ejection fraction also showed reduced SPAP and tricuspid regurgitation velocity. The findings suggest that levosimendan provides acute physiological benefits in PH-related RHF, with potential anti-inflammatory, hepatoprotective, and glycemic-modulating properties. Patient-specific medical history and concomitant medications may influence treatment response. This study offers preliminary evidence supporting the acute physiological effects and tolerability of levosimendan in this population.