{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T15:49:40Z","timestamp":1753890580427,"version":"3.41.2"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,10,20]],"date-time":"2022-10-20T00:00:00Z","timestamp":1666224000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Patients with heart failure frequently present with kidney dysfunction. Kidney function is relevant, as prognosis declines with reduced kidney function and potentially beneficial drugs like levosimendan are contraindicated for missing safety data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>A single-center retrospective registry study was conducted including all patients receiving levosimendan on a medical intensive care unit between January 2010 and December 2019. Exclusion criteria were a follow-up less than 24 h or missing glomerular filtration rate (eGFR) before administration of levosimendan. The first course of treatment was evaluated. Patients were stratified by eGFR before drug administration and the primary endpoint was a composite of supraventricular-, ventricular tachycardia and death within 7 days after administration of levosimendan. An internal control group was created by propensity score matching.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 794 patients receiving levosimendan were screened and 368 unique patients were included. Patients were predominantly male (73.6%) and median age was 63 years. Patients were divided by eGFR into three groups: &amp;gt;60 ml\/min\/1.73 m<jats:sup>2<\/jats:sup> (<jats:italic>n<\/jats:italic> = 110), 60\u201330 ml\/min\/1.73 m<jats:sup>2<\/jats:sup> (<jats:italic>n<\/jats:italic> = 130), and &amp;lt;30 ml\/min\/1.73 m<jats:sup>2<\/jats:sup> (<jats:italic>n<\/jats:italic> = 128). ICU survival was significantly lower in patients with lower eGFR (69.1, 57.7, and 50.8%, respectively, <jats:italic>p<\/jats:italic> = 0.016) and patients with lower eGFR were significantly older and had significantly more comorbidities. The primary combined endpoint was reached in 61.8, 63.1, and 69.5% of subjects, respectively (<jats:italic>p<\/jats:italic> = 0.396). A multivariate logistic regression model suggested only age (<jats:italic>p<\/jats:italic> &amp;lt; 0.020), extracorporeal membrane oxygenation (<jats:italic>p<\/jats:italic> &amp;lt; 0.001) or renal replacement therapy (<jats:italic>p<\/jats:italic> = 0.028) during day 1\u20137 independently predict the primary endpoint while kidney function did not (<jats:italic>p<\/jats:italic> = 0.835). A propensity score matching of patients with eGFR &amp;lt; 30 and &amp;gt;30 ml\/min\/1.73 m<jats:sup>2<\/jats:sup> based on these predictors of outcome confirmed the primary endpoint (<jats:italic>p<\/jats:italic> = 0.886).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The combined endpoint of supraventricular-, ventricular tachycardia and death within 7 days was reached at a similar rate in patients independently of kidney function. Prospective randomized trials are warranted to clarify if levosimendan can be used safely in severely reduced kidney function.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2022.1027727","type":"journal-article","created":{"date-parts":[[2022,10,20]],"date-time":"2022-10-20T09:43:55Z","timestamp":1666259035000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Levosimendan in acute heart failure with severely reduced kidney function, a propensity score matched registry study"],"prefix":"10.3389","volume":"9","author":[{"given":"Felix Arne","family":"Rottmann","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ann Katrin","family":"Breiden","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xavier","family":"Bemtgen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Welte","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Supady","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tobias","family":"Wengenmayer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dawid Leander","family":"Staudacher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,10,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e254","DOI":"10.1161\/CIR.0000000000000950","article-title":"American Heart Association council on epidemiology and prevention statistics committee and stroke statistics subcommittee. heart disease and stroke statistics-2021 update: a report from the American Heart Association.","volume":"143","author":"Virani","year":"2021","journal-title":"Circulation."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1421","DOI":"10.1007\/s00392-020-01781-z","article-title":"Cardiogenic shock: incidence, survival and mechanical circulatory support usage 2007\u20132017-insights from a national registry.","volume":"110","author":"Lang","year":"2021","journal-title":"Clin Res Cardiol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1659","DOI":"10.1016\/j.jacc.2018.12.084","article-title":"Standardized team-based care for cardiogenic shock.","volume":"73","author":"Tehrani","year":"2019","journal-title":"J Am Coll Cardiol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.1002\/ccd.28307","article-title":"Investigators on behalf of the NCSI. improved outcomes associated with the use of shock protocols: updates from the national cardiogenic shock initiative.","volume":"93","author":"Basir","year":"2019","journal-title":"Catheteriz Cardiovasc Interv."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1527","DOI":"10.1016\/j.jacc.2008.07.051","article-title":"Cardiorenal syndrome.","volume":"52","author":"Ronco","year":"2008","journal-title":"J Am Coll Cardiol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"2691","DOI":"10.1016\/j.jacc.2019.02.071","article-title":"Burden and outcomes of heart failure hospitalizations in adults with chronic kidney disease.","volume":"73","author":"Bansal","year":"2019","journal-title":"J Am Coll Cardiol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure.","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur Heart J."},{"key":"B8","doi-asserted-by":"publisher","first-page":"C2","DOI":"10.1093\/eurheartj\/sux001","article-title":"The inodilator levosimendan as a treatment for acute heart failure in various settings.","author":"Gustafsson","year":"2017","journal-title":"Eur Heart J Suppl."},{"key":"B9","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1002\/ejhf.991","article-title":"Long-term safety of intravenous cardiovascular agents in acute heart failure: results from the European Society of Cardiology Heart Failure Long-Term Registry.","volume":"20","author":"Mebazaa","year":"2018","journal-title":"Eur J Heart Fail."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1064","DOI":"10.1002\/ejhf.1557","article-title":"Why has positive inotropy failed in chronic heart failure? 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