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Intravenous levosimendan vs. dobutamine in acute decompensated heart failure patients on beta-blockers
Sahlgrens University Hospital.
Sahlgrens University Hospital.
Linköping University, Department of Medicine and Health Sciences, Cardiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.ORCID iD: 0000-0001-6353-8041
Rikshosp University Hospital.
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2010 (English)In: EUROPEAN JOURNAL OF HEART FAILURE, ISSN 1388-9842, Vol. 12, no 4, 404-410 p.Article in journal (Refereed) Published
Abstract [en]

Aims The 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 beta- blocker. Methods and results This 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/m(2); 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 (23.6 +/- 7.6 vs. 28.3 +/- 6.7 mmHg; P = 0.02). No difference was observed between the groups for change in NYHA class, beta- 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 physicians 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. Conclusion A 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.

Place, publisher, year, edition, pages
Oxford University Press , 2010. Vol. 12, no 4, 404-410 p.
Keyword [en]
Levosimendan, Dobutamine, Decompensated heart failure, Invasive monitoring
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-54864DOI: 10.1093/eurjhf/hfq032ISI: 000276049100017OAI: oai:DiVA.org:liu-54864DiVA: diva2:310850
Available from: 2010-04-16 Created: 2010-04-16 Last updated: 2013-09-26

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Dahlström, Ulf

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