Enalapril and carvedilol for preventing chemotherapy-induced left ventricular systolic dysfunction in patients with malignant hemopathies. The OVERCOME trial (preventiOn of left Ventricular dysfunction with Enalapril and caRvedilol in patients submitted to intensive ChemOtherapy for the treatment of Malignant hEmopathies)

intensification of adjunctive therapy in the placebo group.Improvements in patient self-assessment and declines in Btype natriuretic peptide levels with levosimendan persisted for 5 days and were associated with reduced length of hospital stay (p ¼ 0.009).However, levosimendan was associated with more frequent hypotension and cardiac arrhythmias during the infusion period and a numerically higher risk of death (p ¼ 0.29).An excess risk of deaths in the levosimendan group was apparent as early as 5 days; was nominally significant at 14 days, and was largely seen in subgroups at highest risk of death before entry into the study (eg patients with systolic blood pressure <100 mmHg).After 90 days, the relative risk of death (levosimendan/placebo) was 1.9 in patients with a pretreatment systolic blood pressure <100 mmHg but was 1.1 in patients with a systolic blood pressure >100 mmHg.Conclusions: In patients with ADHF, intravenous levosimendan provided rapid and durable symptomatic relief.However, levosimendan was associated with an increased risk of adverse cardiovascular events.