Assessment of sustained effects of levosimendan and dobutamine on left ventricular systolic functions by using novel tissue Doppler derived indices in patients with advanced heart failure.
BACKGROUND
Previous studies comparing levosimendan vs. dobutamine have revealed that levosimendan is better in relieving symptoms. Echocardiographic studies have been done using second measurements immediately following a dobutamine infusion or while it was still being administered. The aim of our study was assessment of sustained effects of 24 h levosimendan and dobutamine infusions on left ventricular systolic functions.


METHODS
A total of 61 patients with acutely decompensated heart failure with New York Heart Association (NYHA) class III or IV symptoms were randomized to receive either levosimendan or dobutamine 2:1 in an open label fashion. Before and 5 days after the initiation of infusions, functional class was assessed, N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) levels and left ventricular ejection fraction (LVEF), mitral inflow peak E and A wave velocity, and E/A ratios were measured; using tissue Doppler imaging, isovolumic myocardial acceleration (IVA), peak myocardial velocity during isovolumic contraction (IVV), peak systolic velocity during ejection period (Sa), early (E') and late (A') diastolic velocities, and E'/A' and E/E' ratios were measured.


RESULTS
The NYHA class improved in both groups, but improvements were prominent in the levosimendan group. NT-proBNP levels were significantly reduced in the levosimendan group. Improvements in LVEF and diastolic indices were significant in the levosimendan group. Tissue Doppler-derived systolic indices of IVV and IVA increased significantly in the levosimendan group.


CONCLUSIONS
Improvements in left ventricular systolic and diastolic functions continue after a levosimendan infusion.
Department of Cardiology, Istanbul Mehmet Akif Er soy Thoracic and Car diovascular Surgery Training and Research Hospital, Istanbul, Turkey. enderoner7@gmail.com.
Ender
E
Oner
Mehmet
M
Erturk
Ali
A
Birant
Aslı
A
Kurtar Mansıroglu
Ibrahim Faruk
IF
Akturk
Huseyin
H
Karakurt
Ahmet Arif
AA
Yalcin
Fatih
F
Uzun
Mustafa Umut
MU
Somuncu
Aydin
A
Yildirim
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004280:Dobutamine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D011724:Pyridazines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D020127:Recovery of Function; D000077464:Simendan; D013318:Stroke Volume / Q000187:drug effects; D013599:Systole / Q000187:drug effects*; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000187:drug effects*
D015415:Biomarkers; D002316:Cardiotonic Agents; D006835:Hydrazones; D010446:Peptide Fragments; D011724:Pyridazines; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D000077464:Simendan; D004280:Dobutamine