Intravenous levosimendan vs. dobutamine in acute decompensated heart failure patients on beta‐blockers

Abstract

AimsThe aim of this study is to compare the effects of a 24 h intravenous infusion of levosimendan and a 48 h infusion of dobutamine on invasive haemodynamics in patients with acutely decompensated chronic NYHA class III–IV heart failure. All patients were receiving optimal oral therapy including a β-blocker.Methods and resultsThis was a multinational, randomized, double-blind, phase IV study in 60 patients; follow-up was 1 month. There was a significant increase in cardiac index and a significant decrease in pulmonary capillary wedge pressure (PCWP) at 24 and 48 h for both dobutamine and levosimendan. The improvement in cardiac index with levosimendan was not significantly different from dobutamine at 24 h (P = 0.07), but became significant at 48 h (0.44 ± 0.56 vs. 0.66 ± 0.63 L/min/m2; P = 0.04). At 24 h, the reduction in the mean change in PCWP from baseline was similar for levosimendan and dobutamine, however, at 48 h the difference was more marked for levosimendan (−3.6 ± 7.6 vs. −8.3 ± 6.7 mmHg; P = 0.02). No difference was observed between the groups for change in NYHA class, β-blocker use, hospitalizations, treatment discontinuations or rescue medication use. Reduction in B-type natriuretic peptide (BNP) was significantly greater with levosimendan at 48 h (P = 0.03). According to physician's assessment, the improvement in fatigue (P = 0.01) and dyspnoea (P = 0.04) was in favour of dobutamine treatment, and hypotension was significantly more frequent with levosimendan (P = 0.007). No increase in atrial fibrillation or ventricular tachycardia was seen in either group.ConclusionA 24 h levosimendan infusion achieved haemodynamic and neurohormonal improvement that was at least comparable at 24 h and superior at 48 h to a 48 h dobutamine infusion.

Effects of a myofilament calcium sensitizer on left ventricular systolic and diastolic function in rats with volume overload heart failure

“…This can result in increased myocardial oxygen consumption and myocardial Ca 2ϩ overload (30). Newer therapeutics target myofilament activation without altering the Ca 2ϩ transient, and these myofilament Ca 2ϩ sensitizers (e.g., levosimendan, Levo) and myosin activators (e.g., omecamtiv mecarbil, OM) are used to treat acute and chronic HF (5,20,37).…”

Scandinavian SSAI clinical practice guideline on choice of inotropic agent for patients with acute circulatory failure

“…In an updated meta‐analysis comprising six trials, we found no statistically significant difference in short‐term mortality,27, 28, 29, 30, 31, 32 long‐term mortality,27, 30, 31, 33, 34, 35 ischemic events,30, 34 acute kidney injury,31 dysrhythmias,30, 36 or hospital length‐of‐stay37 in patients with cardiogenic shock treated with dobutamine vs. levosimendan (Fig. 3, Fig.…”

The Use of Nitroglycerin and Dobutamine in Intensive Therapy of Cancer Patients with Upper Vena Cava Syndrome

“…А також частота виникнення шлу-ночкової тахікардії була вище, ніж при застосуванні добутаміну [9]. При застосуванні β-блокаторів че-рез 48 годин після початку 24-годинної інфузії ле-восимендану, вплив на гемодинамічні показники були кращі, ніж після 48-годинної інфузії добутамі-ну [11].…”