Survival of Patients With Acute Heart Failure in Need of Intravenous Inotropic Support: a Multicentre, Parallel-Group, Randomised, Double-Blind, Double-Dummy Study of Levosimendan Versus Dobutamine in Patients With Acute Heart Failure.

Inclusion Criteria:

• Written, signed and dated informed consent

• Male and female patients over 18 years of age. Females of childbearing potential musthave a negative pregnancy test and must refrain from breastfeeding. Women who arepostmenopausal [two years since last menstrual cycle], surgically sterilised or whohave undergone a hysterectomy are considered not to be of childbearing potential

• Hospitalised patients with acutely decompensated heart failure

• Left ventricular ejection fraction less than or equal to 30 % as assessed usingechocardiography, radionuclide ventriculography or contrast angiography within 12months

• Clinical need for intravenous inotropic support as evidenced by insufficient responseto intravenous diuretics and/or vasodilators (nitroglycerin, nitroprusside) and atleast one of the following at screening:

• oliguria (mean urine output < 30 ml/h for at least 6 hours) and not a result ofhypovolemia

• dyspnoea at rest or mechanical ventilation for heart failure

• haemodynamic impairment in those patients with Swan-Ganz catheter inserted (PCWP ≥ 18 mmHg and/or Cardiac Index ≤ 2.2 l/min/m2)

Exclusion Criteria:

• Severe obstruction of ventricular outflow tracts such as haemodynamically significantuncorrected primary valve disease or hypertrophic cardiomyopathy or impairedventricular filling such as restrictive cardiomyopathy

• Weight ≥ 160 kg

• Cardiac surgery within 30 days before screening

• Stroke within 3 months before screening

• Systolic blood pressure persistently less than 85 mmHg at screening or at baseline

• Heart rate persistently 130 bpm or greater at screening or at baseline

• Serum potassium less than 3.5 mmol/l at screening

• Administration of any inotropic agent (e.g. dobutamine, milrinone, amrinone,enoximone, epinephrine, norepinephrine) except digitalis or dopamine (with dose ofless than or equal than 2 mg/kg/min) during the current hospitalisation

• Hypersensitivity to levosimendan or dobutamine or any of their excipients

• A history of Torsades de Pointes

• Severe renal insufficiency (serum creatinine > 450 mmol/l [5.0 mg/dl]) or on dialysis

• Significant hepatic impairment at discretion of the investigator

• Acute bleeding

• Severe anemia (haemoglobin < 8 g/dl) at screening

• Septicaemia or septic shock

• Other serious diseases limiting life expectancy considerably (e.g. end-stage cancer)

• Participation in a clinical trial with any experimental treatment within 30 days priorto screening or previous participation in the present study

• Administration of levosimendan within 30 days prior to screening