The calcium (Ca2+)-sensitizer, levosimendan, is recommended by the European Heart Association and the European Society of Intensive Care Medicine for the treatment of low output heart failure, when standard treatment is insufficient . Despite encouraging results from experimental and randomized clinical studies, a recent large randomized, double-blind, multicenter trial in patients with acute decompensated heart failure (Survival Of Patients With Acute Heart Failure In Need Of Intravenous Inotropic Support, SURVIVE study), did not reveal any significant reduction in 31- or 180-day mortality with levosimendan compared to dobutamine . The elementary question that needs to be addressed and was recently elegantly worded by Dr. Butler and colleagues, is whether to abandon or not to abandon levosimendan? .
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