Levosimendan exerts its positive inotropic effect by increasing calcium sensitivity of myocytes by binding to cardiac troponin C in a calcium-dependent manner.

Some of the Phase III studies in the extensive clinical program including the trials LIDO (200 patients), RUSSLAN (500), REVIVE-I (100), REVIVE-II (600) and SURVIVE (1350).

In total, the clinical data base includes more than 3500 patients in Phase IIb and III double-blind randomized studies.

[3] However, in a retrospective subgroup analysis, Levosimendan was superior to dobutamine for treating patients with a history of CHF or those on beta-blocker therapy when they were hospitalized with acute decompensations.

[5] Since then 60 countries worldwide have approved the drug for acute cardiac care, but it remains unapproved in North America, where it is currently in Phase III development by Tenax Therapeutics for reduction in morbidity in patients with Pulmonary Hypertension derived from Heart Failure with preserved Ejection Faction (PH-HFpEF).