Ventricular remodeling phenotypes following intermittent levosimendan therapy in advanced heart failure

Levosimendan is commonly used in patients with advanced heart failure to improve symptoms and reduce hospitalizations. However, individual response is highly variable, and factors associated with meaningful myocardial remodeling remain poorly defined.

To characterize a ventricular remodeling responder phenotype in patients receiving intermittent levosimendan and to explore its relationship with treatment exposure.

We conducted a study including patients with advanced heart failure treated with intermittent levosimendan. Echocardiographic and clinical data were collected at baseline and follow-up. Ventricular remodeling was defined as an absolute increase in left ventricular ejection fraction of at least 5%. Patients were stratified according to the number of levosimendan cycles received. Categorical and non-parametric comparisons were performed as appropriate.

Twenty-six patients had paired echocardiographic data available. Seven patients (27%) met criteria for ventricular remodeling responders. Responders required fewer levosimendan cycles compared with non-responders. A higher response rate was observed among patients who demonstrated remodeling after a single levosimendan cycle (75%) compared with those requiring two or more cycles to achieve follow-up assessment (18%, Fisher exact p = 0.047), indicating that meaningful ventricular remodeling, when present, tends to occur early during treatment and may obviate the need for further cycles.

In advanced heart failure, meaningful ventricular remodeling following intermittent levosimendan therapy identifies a distinct responder phenotype that manifests early and may reduce the need for further treatment cycles. These findings support the concept of an early biological response to levosimendan and may help refine patient selection and treatment strategies.