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This multicentre, randomised trial evaluated the efficacy and safety of the inotropic agent levosimendan in patients with LV dysfunction undergoing cardiac surgery. 882 patients were randomised to receive either intravenous levosimendan (0.2 μg/kg/min for 1h then 0.1 μg/kg/min for 23h) or placebo infusion, starting before surgery. The two primary end-points were a 4-component composite of death through day 30, renal -replacement therapy through day 30, perioperative MI through day 5, or use of a mechanical cardiac assist device through day 5; and a two-component composite of death through day 30 or use of a mechanical cardiac assist device through day 5. In the modified intention-to-treat population, the 4-component primary end -point occurred in 24.5% of patients in each group (p=NS) and the 2-component primary end-point occurred in 13.1% and 11.4% of patients in the levosimendan and placebo groups, respectively (p=NS). Optimising LV performance prior to cardiac surgery intuitively sounds like a good idea but this study using the calcium sensitising agent levosimendan preoperatively in patients with depressed ejection fraction did not improve outcomes postoperatively. Intra- aortic balloon pump when used in this context reduces perioperative and 30-day mortality, so should be considered in preference to levosimendan or inotropic support pre-bypass surgery, if LV function is poorNebilet® (nebivolol hydrochloride) tablets 1.25 mg, 5 mg, 10 mg. INDICATIONS: Essential hypertension. Stable chronic heart failure (CHF) as an adjunct to standard therapies in patients 70 years or older. CONTRAINDICATIONS: Hypersensitivity to the active or any of the excipients; liver insufficiency or liver function impairment; acute heart failure; cardiogenic shock or episodes of heart failure decompensation requiring IV inotropic therapy; sick sinus syndrome, including sino-atrial block; second and third degree heart block (without a pacemaker); history of bronchospasm (e.g. including COPD) and/or asthma; untreated phaeochromocytoma; metabolic acidosis; bradycardia (HR < 60 bpm prior to starting therapy); hypotension (systolic BP < 100 mmHg); severe peripheral circulatory disturbances. PRECAUTIONS: Avoid abrupt cessation unless clearly indicated – reduce dosage gradually over 1-2 wks; refer to full PI. If it must be withdrawn abruptly, close observation is required. Anaesthesia; untreated congestive heart failure, unless stabilised; bradycardia; peripheral circulatory disorders (e.g. Raynaud’s disease, intermittent claudication); first degree heart block; Prinzmetal’s or variant angina; lipid and carbohydrate metabolism – does not affect glucose levels in diabetic patients, but may mask symptoms of hypoglycaemia.