Open-Label Rollover Study of Levosimendan in PH-HFpEF Patients

This study will enroll PH-HFpEF patients that have completed a controlled levosimendan study.
These patients will receive weekly open-label doses of levosimendan and be periodically
evaluated for safety and effectiveness in extended use.

Inclusion Criteria:

1. Provide a personally signed and dated informed consent document prior to initiation of
any study-related procedures that are not considered standard of care.

2. Received levosimendan as treatment for PH-HFpEF in a clinical study sponsored by Tenax
Therapeutics, Inc.

3. May, in the opinion of the Investigator, benefit from continued levosimendan
treatment.

4. Male patients and female patients of childbearing potential must agree to use a highly
effective method of contraception.

5. Willingness and ability to comply with scheduled visits, treatment plan, laboratory
tests and other study procedures.

Exclusion Criteria:

1. Discontinued treatment in the parent study for any reason other than study completion
or Sponsor termination of the study.

2. Pregnant or breastfeeding women.

3. Local access to commercially available levosimendan