Keywords: 
• refractory congestive heart failure (RCHF) /
• levosimendan /
• loading administration /
• non loading administration

Abstract: Objective To evaluate the efficacy of loading or non loading administration of levosimendan in the treatment of patients with refractory congestive heart failure (RCHF). Methods A randomized, open, control clinical trial was conducted in 40 patients with RCHF.Besides regular treatment, patients in test group (n=20) were given levosimendan injection with initial loading dose of 6-12 μg/kg for 10 min,followed by a continuous infusion of 0.1 μg/(kg·min).While in control group (n=20), patients were given Levosimendan injection with a continuous infusion of 8.7 μg/min for 24 h.Dyspnea, eject fraction(EF),BNP level, blood pressure, heart rate, rhythm of the heart, the function of liver and kidney before and after drug administration were examined.All adverse events during the process were recorded. Results The base line showed there was no significant difference between the 2 groups.Dyspnea degree, general clinical condition, BNP, EF values were all improved, compared with those in patients before treatment.After 30 min of administration, in test group improved dyspnea, decreased systolic and diastolic blood pressure were more greatly than those in control group (P=0.04 and 0.01, respectively).However there were no significant differences of dyspnea degree, decreased BNP, between the 2 groups after administration of 6 h, 24 h, and 72 h.In addition, there was no significant difference in enhanced EF value at 24 h, 72 h between the 2 groups. Conclusion Levosimendan was effective in treating RCHF and could improve hemodynamic, degree of dyspnea and decrease BNP, increase EF value.Compared with loading group, non loading administration of levosimendan in the treatment of RCHF was equivalent, safe, and more convenient.