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Effective therapies for acute decompensated heart failure (ADHF) remain frustratingly elusive. Previous studies of inotropes and nesiritide have raised safety concerns, and a recent evaluation of the vasopressin-receptor blocker tolvaptan showed little benefit (Journal Watch Cardiology Apr 4 2007). A post-hoc analysis of findings from a hemodynamic study of levosimendan, an agent with positive inotropic and vasodilatory effects, suggested an outcome benefit in ADHF. Subsequently, researchers launched the multinational, manufacturer-sponsored SURVIVE (Survival of Patients with Acute Heart Failure in Need of Intravenous Inotropic Support) study, enrolling 1327 adults (mean age, 66.5 years; 72% male) with LV dysfunction who had ADHF and an ins…