title: Comparison of three different regimens of intermittent inotrope infusions for end stage heart failure.
abstract: OBJECTIVE
  Inotrope treatment is often necessary in refractory to optimal management end stage heart failure, when signs of end-organ hypoperfusion appear. The effect of specific inotropes on patient outcome remains controversial. The aim of the study was to compare the effect of levosimendan versus dobutamine, alone or in combination with levosimendan, on the outcome of end-stage heart failure patients, requiring inotropic therapy.
  
  
  RESULTS
  We studied 63 patients in NYHA class IV, refractory to optimal medical therapy, recently hospitalized for cardiac decompensation and stabilized by an intravenous inotrope. They were randomly assigned to intermittent infusions of either a) dobutamine, 10mg/kg/min, versus b) levosimendan, 0.3mg/kg/min, versus c) dobutamine, 10mg/kg/min+levosimendan 0.2 mg/kg/min, each administered weekly, for 6h, over a 6-month period. All patients received amiodarone, 400 mg/day, to suppress the proarrhythmic effects of the inotropes. Baseline characteristics of the 3 groups were similar. At 6 months, survival free from death or urgent left ventricular device implantation was 80% in the levosimendan, 48% in the dobutamine (P=0.037 versus levosimendan), and 43% in the levosimendan+dobutamine (P=0.009 versus levosimendan) group. At 3months, NYHA class improved significantly in all 3 groups, whereas pulmonary capillary wedge pressure decreased (27 ± 4 to 19 ± 8 mmHg, P=0.008) and cardiac index increased (1.5 ± 0.3 to 2.1 ± 0.3 l/min/m(2), P=0.002) significantly only in patients assigned to levosimendan.
  
  
  CONCLUSIONS
  In patients with refractory end-stage heart failure, intermittent administration of levosimendan conferred survival and hemodynamic benefits in comparison to a regimen of intermittent infusions of dobutamine, alone or in combination with levosimendan.
authors.affiliation: 3rd Cardiology Department, University of Athens Medical School, Athens, Greece.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bonios
authors.forename: John V
authors.initials: JV
authors.lastname: Terrovitis
authors.forename: Stavros G
authors.initials: SG
authors.lastname: Drakos
authors.forename: Fotis
authors.initials: F
authors.lastname: Katsaros
authors.forename: Chris
authors.initials: C
authors.lastname: Pantsios
authors.forename: Serafim N
authors.initials: SN
authors.lastname: Nanas
authors.forename: John
authors.initials: J
authors.lastname: Kanakakis
authors.forename: George
authors.initials: G
authors.lastname: Alexopoulos
authors.forename: Savvas
authors.initials: S
authors.lastname: Toumanidis
authors.forename: Maria
authors.initials: M
authors.lastname: Anastasiou-Nana
authors.forename: John N
authors.initials: JN
authors.lastname: Nanas
mesh_terms: D000328:Adult; D000368:Aged; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents