Levosimendan is a new drug for the treatment of decompensated heart failure. In previous studies, levosimendan has been shown to increase cardiac contractility through myofilament calcium sensitisation and induce peripheral and coronary vasodilation by opening ATP-sensitive potassium channels. The elimination half-life of levosimendan is approximately one hour in man. Preclinical studies have shown that levosimendan has an active metabolite, called OR-1896, with a substantially longer elimination half-life than that of the parent drug. The aims of the present studies were to investigate: (1) the role of levosimendan metabolites on the hemodynamic responses achieved by levosimendan infusion and (2) the pharmacokinetics of levosimendan and its metabolites during and after intravenous levosimendan infusions of different durations in patients with severe heart failure. Levosimendan was administered intravenously for 24 hours to 7 days in a total of 134 patients with NYHA functional class III to IV in three different study settings
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