Only 1 study (LION-Heart) delivered a positive outcome on its primary endpoint, but all these studies demonstrated that repeat-cycle levosimendan reduces NT-pro-BNP levels, and there were repeated and clear demonstrations of trends toward reductions in heart failure readmissions and mortality that are consistent with, and corroborate, the findings of meta-analyses.2,24,25. Here, NPPB is linked to heart failure.