Acute and Advanced Heart Failure Blog

Professor Gerhard Pölzl is Chief of the Heart Failure and Heart Transplant Program at the Medical University Innsbruck. His research is focused on clinical studies in advanced and chronic heart failure and on translational studies in cardiomyopathies.

He has been Principal Investigator of the LevoRep clinical trial that tested the efficacy and safety of pulsed infusions of levosimendan in outpatients with advanced heart failure. He is now P.I. of the clinical trial LEODOR, on repetitive use of levosimendan in advanced heart failure.

This blog is focused on the therapeutic options for Acute and Advanced Heart Failure:  new data, new studies, new opinions,  new trends.

Latest posts

22 June 2017

July 2017 post

Heart failure is the leading cause of adult hospitalization in the industrialized world and imposes a substantial burden on the public health. The later stages of heart failure are characterized by a steady decline in quality of life and frequent re-hospitalization for recurrent acutization of the symptoms.1 Most of the re-hospitalizations take place relatively soon after discharge from the index hospitalization. About one quarter of patients are re-hospitalized within one month, and more than 60% of these re-hospitalizations are seen within 15 days after discharge.2

Several clinical studies have been performed on the repetitive use of intravenous levosimendan in Advanced Heart Failure.3 Their results are suggesting that repeated infusions of levosimendan bring advantages to patients with advanced chronic heart failure, both as it regards mortality4 and re-hospitalization.5 However, few of these studies were properly powered. Therefore, a larger study is needed to verify the favorable results.

In the newly commenced LEODOR study ( the efficacy and safety of intermittent levosimendan therapy started during the vulnerable phase after a recent hospitalization for heart failure is tested. The hypothesis is that, compared with placebo, repetitive administration of levosimendan in the post-acute heart failure syndrome discharge period, will be associated with greater clinical stability through 14 weeks as assessed by a composite clinical endpoint consisting of mortality, acute heart failure episodes, and change in natriuretic peptide levels.

References: 1. Fruhwald S et al. Expert Rev Cardiovasc Ther. 2016;14:1335-1347. 2. Dharmarajan K et al. BMJ. 2013;347:f6571. 3. Pölzl G et al. Int J Cardiol 2017 [ePub May 23] doi: 10.1016/j.ijcard.2017.05.081. 4. Silvetti S & Nieminen MS. Int J Cardiol. 2016;202:138-43. 5. Silvetti S et al. ESC Heart Fail 2017 [ePub June 26].

22 June 2017

June 2017 post

Patients in the latest stages of heart failure are severely compromised, with poor quality of life and frequent hospitalizations. Heart transplantation and left ventricular assist device implantation are viable options only for a minority, and intermittent or continuous infusions of positive inotropes may be needed as a bridge therapy or as a symptomatic approach.

In these settings, levosimendan has potential advantages over conventional inotropes such as sustained effects after initial infusion, synergy with beta-blockers, and no increase in oxygen consumption. Levosimendan has been suggested as a treatment that reduces re-hospitalization and improves quality of life (see paper).

A panel of 45 expert clinicians from 12 European countries met to review the literature and envision an appropriately designed and properly powered clinical trial addressing these needs. A composite Global Rank Score was advocated as primary end-point where death, re-hospitalization, and change in N-terminal prohormone-brain natriuretic peptide level are considered in a hierarchical order (see previous FIGHT trial).

22 June 2017

May 2017 post

From April 29 to May 2 at the Palais des Congrès in Paris, the Heart Failure Association of the European Society of Cardiology held its annual meeting.

Within the program, I highlight a series of eleven 30-minutes hands-on tutorials on the use of the inodilator levosimendan in acute and advanced heart failure which were structured in several sessions touching the therapeutic needs and options, the comorbidities, the scientific evidence, the guidelines, and the clinical practice.

The take home message was that the inidilator levosimendan is a safe and valid therapeutic option for patients in advanced heart failure. Chairs and lecturers were from Austria (G.Pölzl, J.Altenberger), Italy (G.Malfatto), Hungary (Z.Papp), Finland (V.-P.Harjola, M.Kivikko), Sweden (K.Karason), Greece (J.Parissis), Denmark (F.Gustafsson), and Germany (D.Kindgen-Milles, C.Tschöpe).

The eleven lectures were collected on tape and can be now seen in YouTube format on a new dedicated educational channel (EPGonline Acute and Advanced Heart Failure)