Effect of levosimendan on E/E' ratio in patients with ischemic heart failure.
BACKGROUND
Levosimendan is a novel positive inotropic calcium sensitizer agent used in acute heart failure. In acute heart failure, it improves hemodynamic parameters more favorably than the conventional positive inotropes. In this study, the effect levosimendan on E/E' ratio as a non-invasive indicator of LV filling pressure was evaluated compared to dobutamine in a prospective, randomized, patient-blind manner.


METHODS
Patients with an LVEF < 40% admitting with acute heart failure attack with ischemic origin were included to this study. Patients were randomized to levosimendan (n=30, mean age: 64+/-10 years, 63% male) or dobutamine (n=32, mean age: 66+/-8 years, 54% male) groups. The ratio of the peak E wave velocity taken from mitral inflow with PW Doppler to the peak E' wave velocity taken from mitral lateral annulus with tissue Doppler was determined. Pre-treatment and 24-hour after the treatment E/E' ratios were calculated and then compared in both groups.


RESULTS
Age, gender, concomitant medications were similar in both groups (p>0.05). There was no difference for pre-treatment baseline E/E' ratios between levosimendan and dobutamine groups (15.7+/-4.0 vs 15.2+/-7.5 respectively, p=0.1). There were significant reductions in post-treatment E/E' ratios in levosimendan (15.7+/-4.0 vs 9.3+/-2.8, p=0.01) and dobutamine groups (15.2+/-7.5 vs 12.9+/-5.6, p=0.04). However, the reduction in levosimendan group was greater compared to dobutamine group (p=0.01).


CONCLUSIONS
Levosimendan causes a greater reduction of E/E' ratio compared to dobutamine in acute systolic left heart failure. This may explain the more favorable hemodynamic effects of levosimendan when compared to conventional positive inotropics in patients with systolic left heart failure.
Duygu
Hamza
H
Ozerkan
Filiz
F
Nalbantgil
Sanem
S
Zoghi
Mehdi
M
Akilli
Azem
A
Akin
Mustafa
M
Nazli
Cem
C
Ergene
Oktay
O
D000368:Aged; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D004280:Dobutamine / Q000627:therapeutic use*; D015150:Echocardiography, Doppler / Q000187:drug effects; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D011446:Prospective Studies; D011724:Pyridazines / Q000627:therapeutic use*; D000077464:Simendan; D016037:Single-Blind Method
D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan; D004280:Dobutamine