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 0.1 μg/kg/min over 24 h. The primary endpoint was improvement in WHO Functional Class (WHO-FC) at day 7, with secondary endpoints including 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) mmHg to 50.16 (44.55, 59.83) mmHg (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.