***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: BACKGROUND Levosimendan is a calcium-sensitizing drug with inotropic and other properties that may improve outcomes in patients with sepsis . METHODS We conducted a double-blind , r and omized clinical trial to investigate whether levosimendan reduces the severity of organ dysfunction in adults with sepsis . Patients were r and omly assigned to receive a blinded infusion of levosimendan ( at a dose of 0.05 to 0.2 μg per kilogram of body weight per minute ) for 24 hours or placebo in addition to st and ard care . The primary outcome was the mean daily Sequential Organ Failure Assessment ( SOFA ) score in the intensive care unit up to day 28 ( scores for each of five systems range from 0 to 4 , with higher scores indicating more severe dysfunction ; maximum score , 20 ) . Secondary outcomes included 28-day mortality , time to weaning from mechanical ventilation , and adverse events . RESULTS The trial recruited 516 patients ; 259 were assigned to receive levosimendan and 257 to receive placebo  . There was no significant difference in the mean ( ±SD ) SOFA score between the levosimendan group and the placebo group ( 6.68±3.96 vs. 6.06±3.89 ; mean difference , 0.61 ; 95 % confidence interval [ CI ] , -0.07 to 1.29 ; P=0.053 ) . Mortality at 28 days was 34.5 % in the levosimendan group and 30.9 % in the placebo group ( absolute difference , 3.6 percentage points ; 95 % CI , -4.5 to 11.7 ; P=0.43 ) . Among patients requiring ventilation at baseline , those in the levosimendan group were less likely than those in the placebo group to be successfully weaned from mechanical ventilation over the period of 28 days ( hazard ratio , 0.77 ; 95 % CI , 0.60 to 0.97 ; P=0.03 ) . More patients in the levosimendan group than in the placebo group had supraventricular tachyarrhythmia ( 3.1 % vs. 0.4 % ; absolute difference , 2.7 percentage points ; 95 % CI , 0.1 to 5.3 ; P=0.04 ) . CONCLUSIONS The addition of levosimendan to st and ard treatment in adults with sepsis was not associated with less severe organ dysfunction or lower mortality .  Levosimendan was associated with a lower likelihood of successful weaning from mechanical ventilation and a higher risk of supraventricular tachyarrhythmia . ( Funded by the NIHR Efficacy and Mechanism Evaluation Programme and others ; LeoPARDS Current Controlled Trials number , IS RCT N12776039 . ) Background — We determined the effects of levosimendan , a calcium sensitizer , on left ventricular ( LV ) diastolic function in patients with LV hypertrophy . Methods and Results — In this prospect i ve , r and omized , blinded study , 23 patients received either levosimendan ( 0.1 and 0.2 & mgr;g · kg−1 · min−1 ; n=12 ) or placebo ( n=11 ) after aortic valve replacement for aortic stenosis . The effects on LV performance , dimensions , filling patterns , and isovolumic relaxation time , as well as systemic hemodynamics , were assessed by pulmonary artery thermodilution catheterization and transesophageal 2-dimensional Doppler echocardiography . To circumvent the confounding effects of the levosimendan-induced hemodynamic changes on Doppler echocardiographic indexes of LV early relaxation , heart rate and mean arterial and central venous pressures were kept constant during levosimendan/placebo infusion by atrial pacing , vasopressor , and colloid infusions . In the levosimendan group , dose-dependent increases in cardiac output ( 28 % ; P<0.001 ) and stroke volume ( 26 % ; P<0.001 ) and a decrease in systemic vascular resistance ( −22 % ; P<0.001 ) were observed . There was a trend for an increase in LV ejection fraction ( 12 % ; P=0.058 ) with levosimendan . There were no significant differences in systolic , diastolic arterial , or LV filling pressures or LV end-diastolic area between the 2 groups . Isovolumic relaxation time decreased ( −23 % ; P<0.001 ) , as did the deceleration slope of early diastolic filling ( −45 % ; P<0.01 ) , whereas peak early diastolic filling velocity ( 16 % , P<0.01 ) and peak late diastolic filling velocity ( 15 % ; P<0.001 ) increased after levosimendan compared with placebo . Conclusion — Levosimendan , in addition to its inotropic effects , exerts a direct positive lusitropic effect in patients with LV hypertrophy as it shortens isovolumic relaxation time and improves LV filling Introduction The purpose of the present study was to investigate microcirculatory blood flow in patients with septic shock treated with levosimendan  as compared to an active comparator drug ( i.e. dobutamine ) . The primary end point was a difference of ≥ 20 % in the microvascular flow index of small vessels ( MFIs ) among groups . Methods The study was design ed as a prospect i ve , r and omized , double-blind clinical trial and performed in a multidisciplinary intensive care unit . After achieving normovolemia and a mean arterial pressure of at least 65 mmHg , 40 septic shock patients were r and omized to receive either levosimendan 0.2 μg·kg-1·min-1 ( n = 20 ) or an active comparator ( dobutamine 5 μg·kg-1·min-1 ; control ; n = 20 ) for 24 hours . Sublingual microcirculatory blood flow of small and medium vessels was assessed by sidestream dark-field imaging . Microcirculatory variables and data from right heart catheterization were obtained at baseline and 24 hours after r and omization . Baseline and demographic data were compared by means of Mann-Whitney rank sum test or chi-square test , as appropriate . Microvascular and hemodynamic variables were analyzed using the Mann-Whitney rank sum test . Results Microcirculatory flow indices of small and medium vessels increased over time and were significantly higher in the levosimendan group as compared to the control group ( 24 hrs : MFIm 3.0 ( 3.0 ; 3.0 ) vs. 2.9 ( 2.8 ; 3.0 ) ; P = .02 ; MFIs 2.9 ( 2.9 ; 3.0 ) vs. 2.7 ( 2.3 ; 2.8 ) ; P < .001 ) . The relative increase of perfused vessel density vs. baseline was significantly higher in the levosimendan group than in the control group ( dMFIm 10 ( 3 ; 23)% vs. 0 ( -1 ; 9)% ; P = .007 ; dMFIs 47 ( 26 ; 83)% vs. 10 ( -3 ; 27 ) ; P < .001 ) . In addition , the heterogeneity index decreased only in the levosimendan group ( dHI -93 ( -100 ; -84)% vs. 0 ( -78 ; 57)% ; P < .001 ) . There was no statistically significant correlation between systemic and microcirculatory flow variables within each group ( each P > .05 ) . Conclusions Compared to a st and ard dose of 5 μg·kg-1·min-1 of dobutamine , levosimendan at 0.2 μg·kg-1·min-1 improved sublingual microcirculatory blood flow in patients with septic shock , as reflected by changes in microcirculatory flow indices of small and medium vessels . Trial registration NCT00800306 Background We aim ed to investigate the effect of levosimendan on biomarkers of myocardial injury and systemic hemodynamics in patients with septic shock . Material / Methods After achieving normovolemia and a mean arterial pressure of at least 65 mmHg , 38 septic shock patients with low cardiac output ( left ventricular ejective fraction ) , LEVF ≤45 % ) were r and omly divided into two groups : levosimendan dobutamine . Patients in the levosimendan and dobutamine groups were maintained with intravenous infusion of levosimendan ( 0.2 μg/kg/minute ) and dobutamine ( 5 μg/kg/minute ) for 24 hours respectively . During treatment we monitored hemodynamics and LVEF , and measured levels of heart-type fatty acid binding protein ( HFABP ) , troponin I ( TNI ) , and brain natriuretic peptide(BNP ) . In addition , the length of mechanical ventilation , intensive care unit ( ICU ) stay , hospital stay , and 28-day mortality were compared between the two groups . Results The levosimendan group and the dobutamine group were well matched with respect to age ( years , 55.4±1 7.5 versus 50.2±13.6 ) and gender ( males , 68.4 % versus 57.9 % ) . Levosimendan-treated patients had higher stroke volume index ( SVI ) , cardiac index ( CI ) , LVEF , and left ventricular stroke work index ( LVSWI ) , and lower extravascular lung water index ( EVLWI ) compared to dobutamine-treated patients ( p<0.05 ) . HFABP , TNI , and BNP in the levosimendan group were less than in the dobutamine group ( p<0.05 ) . There was no difference in the mechanical ventilation time , length of stay in ICU and hospital , and 28-day mortality between the two groups . Conclusions Compared with dobutamine , levosimendan  reduces biomarkers of myocardial injury and improves systemic hemodynamics in patients with septic shock . However , it does not reduce the days on mechanical ventilation , length of stay in ICU and hospital , or 28-day mortality OBJECTIVE To evaluate the effects of levosimendan on hemodynamics and cardiac function in patients with septic shock . METHODS A prospect i ve single-center r and omized controlled trial was conducted . The patients with septic shock admitted to the Department of Critical Care Medicine of the Third Hospital of Hebei Medical University from June 2011 to October 2013 were enrolled . The patients with septic shock received the conventional treatment according to international guidelines for management of severe sepsis and septic shock . Thirty-six patients received the examination of echocardiography and left ventricular ejection fraction (LVEF)≤ 0.45 after fluid resuscitation were enrolled the study , who were divided into two groups according to r and om number table , with 18 cases in each group . After the conventional treatment , the patients in dobutamine group received intravenous injection of 5 μg × kg⁻¹ min⁻¹ dobutamine for 48 hours immediately after fluid resuscitation , and those in levosimendan group received a 24-hour infusion of 5 μg × kg⁻¹ min⁻¹ dobutamine followed by a 24-hour infusion of 0.2 μg × kg⁻¹ × min⁻¹ levosimendan . The hemodynamics and cardiac function were evaluated by pulse indicator continuous cardiac output ( PiCCO ) and ultrasound during treatment . RESULTS Compared with dobutamine group , after the treatment in the levosimendan  group , stroke volume index ( SVI ) , cardiac index ( CI ) and left ventricular stroke work index ( LVSWI ) were significantly increased [ SVI ( mL/m² ) : 39.8 ± 5.4 vs. 37.5 ± 4.5 , t=-2.762 , P=0.020 ; CI ( L × min⁻¹ × m⁻² ) : 4.6 ± 0.7 vs. 3.6 ± 0.7 , t=-9.829 , P=0.000 ; LVSWI ( kg ×min⁻ ¹ m⁻² ) : 33.7 ± 2.4 vs. 28.2 ± 1.2 , t=-6.307 , P=0.000 ] , and central venous pressure ( CVP ) , intrathoracic blood volume index ( ITBVI ) and extravascular lung water index ( EVLWI ) were significantly decreased [ CVP ( mmHg , 1 mmHg=0.133 kPa ) : 8.2 ± 0.9 vs. 12.1 ± 0.8 , t=3.928 , P=0.002 ; ITBVI ( mL/m² ) : 820 ± 42 vs. 978 ± 69 , t=9.472 , P=0.000 ; EVLWI ( mL/kg ) : 6.1 ± 1.6 vs. 8.9 ± 1.7 , t=4.467 , P=0.001 ] . Cardiac ultrasound showed that compared with dobutamine group , in the levosimendan  group , left ventricular end-systolic volume ( LVESI ) and end-diastolic volume ( LVEDI ) were significantly lowered [ LVESI ( mL/m² ) : 32.7 ± 9.2 vs. 48.2 ± 1 
    Output:
    
Blood lactate was significantly reduced in the levosimendan group while there was no difference in MAP , CI , norepinephrine dose and length of ICU stay .
Conclusions Findings from this meta- analysis demonstrated that levosimendan treatment may not reduce mortality in patients with septic shock .