Hemodynamic effects of levosimendan added to dobutamine in patients with decompensated advanced heart failure refractory to dobutamine alone.
A 24-hour infusion of levosimendan was added to dobutamine in 18 patients (aged 63 +/- 9 years) hospitalized for management of decompensated New York Heart Association functional class IV heart failure refractory to a continuous 24-hour infusion of dobutamine (10 microg/kg/min) and furosemide (10 mg/hour); the primary study end point was a >or=40% increase in cardiac index and a >or=25% decrease in pulmonary capillary wedge pressure compared with pretreatment measurements. The primary end point was reached in one of the patients treated with dobutamine alone versus 7 patients (39%) treated with levosimendan and dobutamine combined (p = 0.008), whereas at 24 hours, the combined treatment was associated with a 0.76 +/- 0.78 L/min/m(2) (p = 0.001) mean increase in cardiac index and a 6.4 +/- 7.3 mm Hg (p = 0.002) mean decrease in pulmonary capillary wedge pressure compared with measurements obtained after 24 hours of dobutamine infusion alone. Symptoms were alleviated in all patients, and all but 3 were discharged from the hospital.
Nanas
John N
JN
University of Athens School of Medicine, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece. jnanas@ath.forthnet.gr <jnanas@ath.forthnet.gr>
Papazoglou
Panagiotis P
PP
Terrovitis
John V
JV
Kanakakis
John
J
Dalianis
Argirios
A
Tsolakis
Elias
E
Tsagalou
Eleftheria P
EP
Agrios
Nikolaos
N
Christodoulou
Kostantinos
K
Anastasiou-Nana
Maria I
MI
D000284:Administration, Oral; D002302:Cardiac Output / Q000187:drug effects; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D004232:Diuretics / Q000008:administration & dosage; D004280:Dobutamine / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D005665:Furosemide / Q000008:administration & dosage; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011669:Pulmonary Wedge Pressure / Q000187:drug effects; D011724:Pyridazines / Q000008:administration & dosage*; D000077464:Simendan
D002316:Cardiotonic Agents; D004232:Diuretics; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan; D004280:Dobutamine; D005665:Furosemide