{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:12:14Z","timestamp":1787026334077,"version":"build-2736575974"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T00:00:00Z","timestamp":1776038400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"\n Objective<\/jats:title>\n To evaluate the efficacy and safety of levosimendan in acute heart failure (AHF) patients with different body mass index (BMI) using real-world data.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This retrospective study enrolled 2,398 AHF patients hospitalized at 14 provincial, municipal, and county-level hospitals in Jiangxi Province from March 1, 2023, to March 1, 2025. After excluding 828 cases due to missing data and 60 cases with BMI\u2009&lt;\u200918.5\u2005kg\/m\n 2<\/jats:sup>\n , a total of 1,530 patients were included. Patients treated with levosimendan were categorized into three groups: normal weight group (18.5\u2009\u2264\u2009BMI\u2009&lt;\u200924,\n n<\/jats:italic>\n \u2009=\u2009535), overweight group (24\u2009\u2264\u2009BMI\u2009&lt;\u200928,\n n<\/jats:italic>\n \u2009=\u2009510), and obese group (BMI\u2009\u2265\u200928,\n n<\/jats:italic>\n \u2009=\u2009485). To assess the efficacy and safety of levosimendan in real-world AHF patients overall and across BMI groups, comparisons were made before and 7 days after treatment regarding heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), left ventricular ejection fraction (LVEF), NT-proBNP levels, cardiac function classification, respiratory symptoms, pulmonary rales, and adverse reactions.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n After 7 days of levosimendan treatment, patients showed significant reductions in SBP and DBP compared to pre-treatment levels (\n P<\/jats:italic>\n \u2009&lt;\u20090.01). LVEF significantly increased (\n P<\/jats:italic>\n \u2009&lt;\u20090.01), and NT-proBNP levels significantly decreased (\n P<\/jats:italic>\n \u2009&lt;\u20090.01). Serum creatinine levels also significantly decreased (\n P<\/jats:italic>\n \u2009&lt;\u20090.01). Significant improvements were observed in cardiac function classification, respiratory symptoms, and pulmonary rales (all\n P<\/jats:italic>\n \u2009&lt;\u20090.01). No significant changes were found in heart rate, serum potassium, alanine aminotransferase (ALT), or aspartate aminotransferase (AST) (all\n P<\/jats:italic>\n \u2009&gt;\u20090.05). Baseline NT-proBNP levels differed significantly among the three groups (normal\u2009&gt;\u2009overweight\u2009&gt;\u2009obese,\n P<\/jats:italic>\n \u2009&lt;\u20090.01), a pattern that persisted after 7 days of treatment (\n P<\/jats:italic>\n \u2009&lt;\u20090.01). However, there were no significant differences among the groups in the magnitude of NT-proBNP reduction or the proportion of patients achieving a\u2009\u2265\u200930% reduction in NT-proBNP (\n P<\/jats:italic>\n \u2009&gt;\u20090.05). Compared to the normal weight group, the overweight and obese groups showed significantly greater increases in LVEF after treatment (\n P<\/jats:italic>\n \u2009&lt;\u20090.01), with the obese group showing a significantly greater increase than the overweight group (\n P<\/jats:italic>\n \u2009&lt;\u20090.01). The rates of improvement in cardiac function classification and respiratory symptoms were significantly higher in the overweight and obese groups compared to the normal weight group (\n P<\/jats:italic>\n \u2009&lt;\u20090.01). Although the obese group had slightly higher improvement rates than the overweight group, the difference was not statistically significant (\n P<\/jats:italic>\n \u2009&gt;\u20090.05). The incidence of hypotension was significantly lower in the overweight and obese groups compared to the normal weight group (\n P<\/jats:italic>\n \u2009&lt;\u20090.01). The total incidence of adverse reactions was also significantly lower in the overweight and obese groups (\n P<\/jats:italic>\n \u2009&lt;\u20090.01). Hospital length of stay was significantly shorter in the overweight and obese groups compared to the normal weight group (\n P<\/jats:italic>\n \u2009&lt;\u20090.05). There were no significant differences among the three groups in heart rate, SBP, DBP, pulmonary rales, serum potassium, ALT, AST, serum creatinine, or other adverse reactions after 7 days of treatment (all\n P<\/jats:italic>\n \u2009&gt;\u20090.05).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n 1. In patients with acute heart failure, levosimendan administration was associated with a decreasing trend in plasma NT-proBNP levels, an improvement in left ventricular ejection fraction, and alleviation of cardiac functional impairment and respiratory symptoms. Favorable safety profiles were generally observed during the treatment period. 2. Body mass index showed a negative correlation with NT-proBNP levels, suggesting that patients with higher BMI tend to have relatively lower baseline NT-proBNP levels. 3. In acute heart failure patients stratified by body mass index, levosimendan treatment exhibited between-group variations in clinical parameter improvements and safety profiles. Overweight and obese subgroups demonstrated a tendency toward more pronounced clinical improvement and fewer reported adverse events.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1790085","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T05:48:13Z","timestamp":1776059293000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Efficacy and safety of levosimendan in acute heart failure patients with different body mass index: a multicenter, retrospective, observational real-world study"],"prefix":"10.3389","volume":"13","author":[{"given":"Wenjing","family":"Liu","sequence":"first","affiliation":[{"name":"Jiangxi Medical College, Nanchang University","place":["Nanchang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liu","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Jiangxi Provincial People\u2019s Hospital, The First Affiliated Hospital of Nanchang Medical College","place":["Nanchang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenhuan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Jiangxi Provincial People\u2019s Hospital, The First Affiliated Hospital of Nanchang Medical College","place":["Nanchang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yijie","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First People\u2019s Hospital of Xiushui County","place":["Jiujiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hengli","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Jiangxi Provincial People\u2019s Hospital, The First Affiliated Hospital of Nanchang Medical College","place":["Nanchang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1468","DOI":"10.1161\/CIRCRESAHA.121.318186","article-title":"Pathophysiology and therapeutic approaches to acute decompensated heart failure","volume":"128","author":"Njoroge","year":"2021","journal-title":"Circ Res"},{"key":"B2","doi-asserted-by":"publisher","first-page":"3391","DOI":"10.2147\/DDDT.S295214","article-title":"Evidence and current use of levosimendan in the treatment of heart failure: filling the gap","volume":"15","author":"Conti","year":"2021","journal-title":"Drug Des Devel Ther"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e42599","DOI":"10.1097\/MD.0000000000042599","article-title":"Clinical analysis of atrial fibrillation after levosimendan treatment for acute decompensated heart failure: a propensity score-matched study","volume":"104","author":"Chen","year":"2025","journal-title":"Medicine (Baltimore)"},{"key":"B4","first-page":"5624","article-title":"Levosimendan improves cardiac function, hemodynamics, and body inflammation in patients with acute myocardial infarction and heart failure","volume":"15","author":"Sun","year":"2023","journal-title":"Am J Transl Res"},{"key":"B5","doi-asserted-by":"publisher","first-page":"113391","DOI":"10.1016\/j.biopha.2022.113391","article-title":"The importance of pharmacokinetics, pharmacodynamic and repetitive use of levosimendan","volume":"153","author":"Grze\u015bk","year":"2022","journal-title":"Biomed Pharmacother"},{"key":"B6","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1097\/FJC.0000000000000859","article-title":"Levosimendan efficacy and safety: 20 years of SIMDAX in clinical use","volume":"76","author":"Papp","year":"2020","journal-title":"J Cardiovasc Pharmacol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"492","DOI":"10.5603\/CJ.a2021.0037","article-title":"Efficacy and safety of levosimendan and dobutamine in heart failure: a systematic review and meta-analysis","volume":"28","author":"Jaguszewski","year":"2021","journal-title":"Cardiol J"},{"key":"B8","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1016\/j.ihj.2021.02.010","article-title":"Clinical outcomes of levosimendan versus dobutamine in patients with acute decompensated heart failure with reduced ejection fraction and impaired renal function","volume":"73","author":"John","year":"2021","journal-title":"Indian Heart J"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1487","DOI":"10.1002\/ehf2.13807","article-title":"Intermittent inotropic therapy with levosimendan vs. milrinone in advanced heart failure patients","volume":"9","author":"Milwidsky","year":"2022","journal-title":"ESC Heart Fail"},{"key":"B10","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1097\/FJC.0000000000001561","article-title":"Comparative effectiveness and safety of intermittent, repeated, or continuous use of levosimendan, milrinone, or dobutamine in patients with advanced heart failure: a network and single-arm meta-analysis","volume":"84","author":"Zhang","year":"2024","journal-title":"J Cardiovasc Pharmacol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e984","DOI":"10.1161\/CIR.0000000000000973","article-title":"Obesity and cardiovascular disease: a scientific statement from the American Heart Association","volume":"143","author":"Powell-Wiley","year":"2021","journal-title":"Circulation"},{"key":"B12","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1159\/000527332","article-title":"The obesity paradox in heart failure: is it still valid in light of new therapies?","volume":"147","author":"Fr\u00f6hlich","year":"2022","journal-title":"Cardiology"},{"key":"B13","first-page":"43","article-title":"The obesity paradox in heart failure: time to move forward","volume":"135","author":"Deswal","year":"2025","journal-title":"Trans Am Clin Climatol Assoc"},{"key":"B14","doi-asserted-by":"publisher","first-page":"277","DOI":"10.26599\/1671-5411.2025.03.002","article-title":"Chinese Guidelines for the diagnosis and treatment of heart failure 2024","volume":"22","author":"Zhang","year":"2025","journal-title":"J Geriatr Cardiol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1016\/s0140-6736(02)09455-2","article-title":"Efficacy and safety of intravenous levosimendan compared with dobutamine in severe low-output heart failure (the LIDO study): a randomised double-blind trial","volume":"360","author":"Follath","year":"2002","journal-title":"Lancet"},{"key":"B16","doi-asserted-by":"publisher","first-page":"2222","DOI":"10.1161\/01.cir.102.18.2222","article-title":"Acute hemodynamic and clinical effects of levosimendan in patients with severe heart failure. Study investigators","volume":"102","author":"Slawsky","year":"2000","journal-title":"Circulation"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.echo.2014.10.003","article-title":"Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American society of echocardiography and the European association of cardiovascular imaging","volume":"28","author":"Lang","year":"2015","journal-title":"J Am Soc Echocardiogr"},{"key":"B18","first-page":"83","article-title":"Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults\u2013study on optimal cut-off points of body mass index and waist circumference in Chinese adults","volume":"15","author":"Zhou","year":"2002","journal-title":"Biomed Environ Sci"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1196","DOI":"10.13288\/j.11-2166\/r.2024.11.018","article-title":"Expert consensus on the selection and application of outcome measures in clinical trials for chronic heart failure","volume":"65","author":"Zhu","year":"2024","journal-title":"J Tradit Chin Med"},{"key":"B20","doi-asserted-by":"publisher","first-page":"6131","DOI":"10.62347\/TTLB6414","article-title":"Amiodarone combined with metoprolol improves cardiac function in patients with coronary heart disease complicated by arrhythmia","volume":"17","author":"Fu","year":"2025","journal-title":"Am J Transl Res"},{"key":"B21","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.amjcard.2007.11.026","article-title":"Amino-terminal pro-B-type natriuretic peptide testing for inpatient monitoring and treatment guidance of acute destabilized heart failure","volume":"101","author":"Bettencourt","year":"2008","journal-title":"Am J Cardiol"},{"key":"B22","first-page":"59","article-title":"Potassium disorders: hypokalemia and hyperkalemia","volume":"107","author":"Kim","year":"2023","journal-title":"Am Fam Physician"},{"key":"B23","doi-asserted-by":"publisher","first-page":"225","DOI":"10.3390\/jcdd11070225","article-title":"The role of NT-proBNP levels in the diagnosis and treatment of heart failure with preserved ejection fraction-it is not always a hide-and-seek game","volume":"11","author":"Chrysohoou","year":"2024","journal-title":"J Cardiovasc Dev Dis"},{"key":"B24","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1016\/j.jchf.2021.05.014","article-title":"NT-proBNP for risk prediction in heart failure: identification of optimal cutoffs across body mass Index categories","volume":"9","author":"Vergaro","year":"2021","journal-title":"JACC Heart Fail"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1545","DOI":"10.1002\/ejhf.2618","article-title":"Clinical effect of obesity on N-terminal pro-B-type natriuretic peptide cut-off concentrations for the diagnosis of acute heart failure","volume":"24","author":"Kozhuharov","year":"2022","journal-title":"Eur J Heart Fail"},{"key":"B26","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1536\/ihj.23-461","article-title":"Influence of body mass index on the prognostic value of N-terminal pro-B-type natriuretic peptide level in Chinese patients with heart failure","volume":"65","author":"Tian","year":"2024","journal-title":"Int Heart J"},{"key":"B27","doi-asserted-by":"publisher","first-page":"586240","DOI":"10.3389\/fcvm.2021.586240","article-title":"Body mass index: an effective predictor of ejection fraction improvement in heart failure","volume":"8","author":"Ye","year":"2021","journal-title":"Front Cardiovasc Med"},{"key":"B28","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.ahj.2008.02.014","article-title":"Body mass index and mortality in heart failure: a meta-analysis","volume":"156","author":"Oreopoulos","year":"2008","journal-title":"Am Heart J"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1110","DOI":"10.1038\/ijo.2013.203","article-title":"The obesity paradox in heart failure patients with preserved versus reduced ejection fraction: a meta-analysis of individual patient data","volume":"38","author":"Padwal","year":"2014","journal-title":"Int J Obes (Lond)"},{"key":"B30","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1002\/ehf2.12120","article-title":"Obesity paradox in heart failure: a heavy matter","volume":"3","author":"Nagarajan","year":"2016","journal-title":"ESC Heart Fail"},{"key":"B31","doi-asserted-by":"publisher","first-page":"e70107","DOI":"10.14814\/phy2.70107","article-title":"Reverse epidemiology of obesity paradox: fact or fiction?","volume":"12","author":"Kishore","year":"2024","journal-title":"Physiol Rep"},{"key":"B32","doi-asserted-by":"publisher","first-page":"31","DOI":"10.2147\/POR.S444361","article-title":"Obesity paradox in heart failure with mildly reduced ejection fraction","volume":"15","author":"Reinhardt","year":"2024","journal-title":"Pragmat Obs Res"},{"key":"B33","doi-asserted-by":"publisher","first-page":"60","DOI":"10.3390\/medicina59010060","article-title":"Obesity paradox among heart failure with reduced ejection fraction patients: a retrospective cohort study","volume":"59","author":"Alrob","year":"2022","journal-title":"Medicina (Kaunas)"},{"key":"B34","doi-asserted-by":"publisher","first-page":"778620","DOI":"10.3389\/fmed.2022.778620","article-title":"Effect of levosimendan on acute decompensated right heart failure in patients with connective tissue disease-associated pulmonary arterial hypertension","volume":"9","author":"Qu","year":"2023","journal-title":"Front Med (Lausanne)"},{"key":"B35","doi-asserted-by":"publisher","first-page":"e028750","DOI":"10.1136\/bmjopen-2018-028750","article-title":"Development of hypotension in patients newly diagnosed with heart failure in UK general practice: retrospective cohort and nested case-control analyses","volume":"9","author":"Mart\u00edn-P\u00e9rez","year":"2019","journal-title":"BMJ Open"},{"key":"B36","doi-asserted-by":"publisher","first-page":"e005661","DOI":"10.1161\/JAHA.117.005661","article-title":"Graded association between kidney function and impaired orthostatic blood pressure stabilization in older adults","volume":"6","author":"Canney","year":"2017","journal-title":"J Am Heart Assoc"},{"key":"B37","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1159\/000528431","article-title":"Effect of orthostatic hypotension on kidney function","volume":"147","author":"Na","year":"2023","journal-title":"Nephron"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1790085\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T05:48:15Z","timestamp":1776059295000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1790085\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,13]]},"references-count":37,"alternative-id":["10.3389\/fcvm.2026.1790085"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1790085","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,13]]},"article-number":"1790085"}}