(Vienna, 08 July 2025) Levosimendan is an established drug in cardiology that strengthens the contractile force of the heart muscle and is used in certain forms of acute heart failure. A study has now investigated whether levosimendan can also help to prevent undetected but measurable cardiac stress after major non-cardiac surgery. The results, currently published in the journal Nature Communications, do not support routine use for this indication.
The double-blind, placebo-controlled Phase III study was conducted by a research team led by Christian Reiterer and Edith Fleischmann and by the Department of Anaesthesia, Intensive Care Medicine and Pain Medicine at MedUni Vienna. In the study, 230 patients were given either a single infusion of levosimendan or a placebo prior to planned major surgery. The aim was to investigate whether the active ingredient reduces the increase in NT-proBNP – a measure of cardiac stress – after surgery. The result: no significant difference was found between the two groups. No clear advantage of levosimendan was found in relation to other measurements such as troponin T – an indicator of heart muscle damage – or the occurrence of myocardial ischaemia (MINS). Lower NT-proBNP levels in the levosimendan group on the third and fifth days after surgery could indicate a delayed effect, but this was not conclusive from a scientific point of view and has no immediate consequences for treatment practice.
Cardiovascular complications are among the most common causes of health problems or death after non-cardiac surgery. People over the age of 45 are particularly affected – around one third of patients in this age group develop a complication after such an operation. In many cases, the underlying heart strain initially remains unnoticed (known as subclinical heart failure), but can be detected by laboratory tests. An important indicator here is NT-proBNP, a substance released by the heart when there is increased pressure in the heart wall. After major surgery, the level can rise four to five times. This increase is considered an indication of an increased risk of post-operative complications, even if the patient has no symptoms.
NT-proBNP is a protein released by the heart when the wall tension increases. After major surgery, the level rises significantly in many patients, often four to five times higher. This increase is considered an indication of a temporary, unnoticed impairment of heart function (subclinical heart failure), which may be associated with an increased risk of complications. Levosimendan is an established drug in cardiology that improves the heart's contractile force and is used in certain forms of acute heart failure. Its preventive effect in non-cardiac surgery was specifically investigated for the first time in this study. However, the results do not support the routine use of levosimendan to prevent subclinical cardiac stress after non-cardiac surgery. Further studies are needed to clarify possible long-term effects.
Publication: Nature Communications
Levosimendan for postoperative subclinical heart failure after noncardiac surgery: a randomised, double-blinded, phase III trial
Christian Reiterer, Barbara Kabon, Alexander Taschner, Alexandra Graf, Nikolas Adamowitsch, Katharina Horvath, David Emler, Oliver Zotti, Nicole Hantakova, Beatrix Hochreiter, Melanie Fraunschiel, Theresa Clement & Edith Fleischmann
https://www.nature.com/articles/s41467-025-60601-y