Magnitude of Blood Pressure Reduction in Response to Levosimendan Infusion Independently Predicts In-Hospital Mortality in Patients With Acute Heart Failure.

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) was significantly associated with higher in-hospital mortality (delta-SBP in survivors: 10.1 ± 19.1 mm Hg vs. in nonsurvivors: 21.4 ± 23.6 mm Hg, P = 0.023; delta-MAP in survivors: 8.8 ± 15.8 mm Hg vs. in nonsurvivors: 17.8 ± 23.3 mm Hg, P = 0.034), regardless of baseline BP values and despite the fact that most patients had absolute values of SBP after levosimendan infusion >90 mm Hg. 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 mm Hg, 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.