Better understanding of the vascular biology and neurochemistry that underlie heart failure has sparked development of novel compounds with therapeutic potential. Several agents have progressed to clinical evaluation, including the calcium sensitiser levosimendan, vasopressin antagonists and an endothelin antagonist. Encouraging results have emerged from recent clinical studies of each of the compounds, as reported at the 3rd Annual Scientific Meeting of the Heart Failure Society of America [San Francisco, US; September, 1999].