Repetitive use of levosimendan in clinical practice: a case series.

Levosimendan was developed as a treatment for acute decompensation of severe heart failure (HF). Its use has evolved during recent years, and new HF treatment strategies in different settings have been developed. This case series aimed to show indications for the use of levosimendan and to discuss the treatment response in various settings. Repetitive levosimendan infusions were found to be safe and effective. They seemed to prolong the time of clinical stability, although they did not alter the eventual natural history of HF, with increasing frequency of hospitalisations and rising natriuretic peptide levels.