Comparative effects of levosimendan and dobutamine on right ventricular function in patients with biventricular heart failure.
Severe heart failure represents a major source of morbidity and mortality. Poor right ventricular function is an independent prognostic marker for mortality in patients with chronic heart failure. In this study, levosimendan (L) and dobutamine (D) in patients with severe chronic biventricular failure were compared. Forty consecutive patients, who were judged for inotropic therapy by their primary physicians, with acutely decompensated systolic heart failure and having moderate-to-severe right ventricular dysfunction with right ventricular fractional area change of <or= 24%m were randomized to L and D in a 2:1 fashion. Echocardiographic parameters including tricuspid annular motion and clinical issues were considered. Mean age and sex distribution were not different between the two groups. After the infusion, ejection fraction improved and systolic pulmonary artery pressure decreased significantly in both arms. Longitudinal systolic function of tricuspid annulus improved significantly better in patients with L compared to patients with D (15%+/-12% vs. 2%+/-6% improvement, P<0.001). Furthermore, L improved both 24-h urine output and creatinine, whereas D showed only a small, but significant improvement in urine output without any improvement in the creatinine levels. Levosimendan seems to offer more beneficial effects compared to dobutamine in a specific group of patients with biventricular failure.
Yilmaz
Mehmet Birhan
MB
Department of Cardiology, Cumhuriyet University School of Medicine, L Blok Daire 1, 58140 Sivas, Turkey. cardioceptor@gmail.com
Yontar
Can
C
Erdem
Alim
A
Karadas
Filiz
F
Yalta
Kenan
K
Turgut
Okan Onur
OO
Yilmaz
Ahmet
A
Tandogan
Izzet
I
D000368:Aged; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D003971:Diastole; D004280:Dobutamine / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011724:Pyridazines / Q000008:administration & dosage*; D000077464:Simendan; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology; D013599:Systole; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology; D016278:Ventricular Function, Right / Q000187:drug effects* / Q000502:physiology
D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan; D004280:Dobutamine