In acute heart failure patients treated with levosimendan, each mmHg larger drop in systolic BP increased in-hospital mortality risk by ~5% (OR 1.051).
Does the magnitude of blood pressure reduction after levosimendan infusion predict in-hospital mortality in patients with acute heart failure?
In patients with acute heart failure treated with levosimendan, a greater drop in systolic blood pressure independently predicts higher in-hospital mortality, highlighting the importance of careful hemodynamic monitoring.
The impact of blood pressure (BP) reduction induced by levosimendan infusion on in-hospital mortality in patients with acute heart failure (AHF) and systolic ventricular dysfunction still needs to be clarified. We conducted a retrospective cohort study involving 161 patients hospitalized for AHF and treated with a 24-hour infusion of levosimendan between 2017 and 2024, following a standard protocol. During hospitalization, biometric, clinical, laboratory, and echocardiographic parameters were assessed. The results revealed that the difference in systolic and mean BP before and after levosimendan infusion (delta-SBP and delta-MAP) were significantly associated with higher in-hospital mortality (delta-SBP in survivors: 10.1±19.1 mmHg vs. in non-survivors: 21.4±23.6 mmHg, p=0.023; delta-MAP in survivors: 8.8±15.8 mmHg vs. in non-survivors: 17.8±23.3 mmHg, p=0.034), regardless of baseline BP values and despite the fact that the majority of patients had absolute values of SBP after levosimendan infusion >90 mmHg. Multivariable analysis confirmed that a larger reduction in SBP was an independent predictor of in-hospital mortality (OR: 1.053, 95% CI: 1.015-1.092, p=0.006). Absolute values of SBP after levosimendan infusion (post-SBP) were also independently associated with mortality (OR: 0.942, 95% CI: 0.896-0.990, p=0.019). However, when the analysis was repeated in a subgroup of subjects with SBP after infusion >90 mmHg, only delta-SBP remained independently associated with mortality (OR 1.051, 95% CI 1.009-1.095, p=0.017). In patients with AHF treated with levosimendan, larger reductions in SBP after therapy are independently associated with in-hospital mortality. Monitoring SBP changes after levosimendan infusion may improve risk stratification and guide clinical decisions.
Santo et al. (2026) studied this question. In acute heart failure patients treated with levosimendan, each mmHg larger drop in systolic BP increased in-hospital mortality risk by ~5% (OR 1.051).