In ambulatory advanced heart failure (HF) patients, switching from milrinone to levosimendan based intermittent inotropic therapy (IIT) resulted in improvements in right ventricular systolic function, maximal O ₂ consumption, and B-natriuretic peptide (BNP).

• In this single-center small-scale study, consecutive ambulatory advanced HF patients that received ≥4 cycles of once-weekly milrinone IIT, who were switched to levosimendan IIT, were included.

• The cohort comprised 11 patients, 10 (91%) were male and the mean age was 76 ± 12 years.

• After 4 weeks of levosimendan therapy, improvement in maximal O ₂ consumption by a mean of 2.28 mL/kg occurred in 8/9 (89%) patients.

• A total of 9/11 (82%) levosimendan treated patients showed reduction in BNP levels, from a median of 1015 ng/L [261–1035] to 719 ng/L [294–739].

• Improvement in quality of life was seen in 8/11 (82%) patients after levosimendan IIT.

• Increase in peak systolic annular velocity on echocardiography by an average of 3 cm/s was evident after levosimendan IIT.