Effects of levosimendan versus dobutamine on left atrial function in decompensated heart failure.
BACKGROUND
Although the effects of levosimendan on the left ventricle (LV) have been studied, its effect on left atrial (LA) function is poorly understood, despite its key role in optimizing LV function.


OBJECTIVE
To compare the effects of levosimendan and dobutamine on LA and LV function in patients with decompensated heart failure (DHF).


METHODS
Seventy-four patients (mean [+/- SD] age 64+/-10 years) with DHF and an LV ejection fraction of 35% or lower were randomly assigned to receive levosimendan (n=37) or dobutamine (n=37). LA active emptying fraction, LA passive emptying fraction (PEF) and the ratio of mitral inflow early diastolic velocity to annulus velocity (E/e) were evaluated with pulsed wave and tissue Doppler imaging along with plasma B-type natriuretic peptide (BNP) level measurements before and after drug infusion.


RESULTS
The ejection fraction was significantly increased in both groups. The levosimendan group had a greater decrease in BNP and a greater increase in active emptying fraction at 24 h compared with the dobutamine group. The PEF, E/e and deceleration time of the E wave were significantly improved in the levosimendan group, but not in the dobutamine group. Levosimendan- induced percentage change of BNP was significantly correlated with the percentage change of E/e and PEF (r=0.48 [P<0.005] and r=-0.38 [P<0.05], respectively).


CONCLUSIONS
In patients with DHF, levosimendan and dobutamine both improve LV systolic function. However, levosimendan also improves LV diastolic function and LA performance in parallel with a greater improvement in neurohormonal activation compared with dobutamine.
Duman
Duman
D
Department of Cardiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey. drduman@excite.com
Palit
Fatih
F
Simsek
Ergun
E
Bilgehan
Karadag
K
Sacide
Atalay
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016279:Atrial Function, Left / Q000187:drug effects* / Q000502:physiology; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004280:Dobutamine / Q000008:administration & dosage / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011724:Pyridazines / Q000008:administration & dosage / Q000627:therapeutic use*; D000077464:Simendan; D016037:Single-Blind Method; D016896:Treatment Outcome; D055815:Young Adult
D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan; D004280:Dobutamine