Pharmacokinetics of Inhaled Levosimendan

Inclusion Criteria: * Subject \>18 years of age * Scheduled for elective coronary artery bypass grafting (CABG) * Provided written informed consent * Impaired left ventricular function (LVEF \<40%) Exclusion Criteria: * Known allergy for levosimendan or solutes * Persistent angina, defined as Canadian Cardiovascular Society score \> I * History of valvular intervention or uncorrected primary stenotic valve disease * Uncorrected thyroid disease * Infiltrative, hypertrophic or restrictive cardiomyopathy * Pericardial disease * Active myocarditis * Chronic obstructive pulmonary disease requiring long-term treatment with β-agonists, Theophylline, or corticosteroids (FEV1 \< 80%; Tiffeneau-index \<0.7) * History of serious arrhythmias, defined as a history of ventricular tachycardia or fibrillation other than that occurring within 24 hours after acute myocardial infarction (MI) * resting heart rate \> 115 bpm for at least 10 minutes on repeated measurements * Supine systolic blood pressure \< 85 mm Hg or \>200 mm Hg * patients with implanted pacemaker/defibrillator or cardiac resynchronisation therapy (CRT-device) * primary renal or hepatic impairment (creatinine \> 2.5 mg/dL or aspartate aminotransferase/alanine aminotransferase \>2 times upper limit of normal and/or increased level of bilirubin (\> 2 times the upper limit of normal and increase of international normalised ratio (INR) above the upper limit of normal, respectively) * Uncorrected hypokalemia or hyperkalemia (pot…