This year marks the 20th anniversary of levosimendan in clinical use. To commemorate this milestone, the Journal of Cardiovascular Pharmacology is jointly publishing a general review and opinion paper with Cardiac Failure Review. As described in this paper, levosimendan has evolved beyond its original indication of acute heart failure in adults. It has demonstrated encouraging effects in various conditions where inotropy may be appropriate, including Takotsubo cardiomyopathy, cardiogenic and septic shock, and right ventricular failure. In addition, expansion into pediatric cardiovascular medicine is being explored and assessment of its potential in the management of pulmonary hypertension in heart failure patients with preserved ejection fraction (HFpEF) is being advanced. Levosimendan is also being evaluated in situations that lie outside cardiovascular medicine, including ALS and ICU-acquired weakness of the respiratory muscles. Access the full review here Levosimendan Efficacy and Safety: 20 Years of SIMDAX in Clinical Use. Happy anniversary levosimendan!