title: Comparison of the Effects of Levosimendan Dobutamine and Vasodilator Therapy on Ongoing Myocardial Injury in Acute Decompensated Heart Failure.
abstract: BACKGROUND
  Cardiac troponins (cTn) are reliable and the most sensitive biomarker in the setting of acute decompensated heart failure (ADHF). Acute decompensated heart failure is usually associated with worsening chronic heart failure, and it may be caused by ongoing minor myocardial cell damage that may occur without any reported precipitating factors.
  
  
  METHODS
  We compared the short-term effect of levosimendan (LEV), dobutamine (DOB), and vasodilator treatment (nitroglycerin [NTG]) on myocardial injury with hemodynamic, neurohumoral, and inflammatory indicators. One hundred twenty-two patients with a mean age of 66 ± 9 years were treated with LEV (n = 40), DOB (n = 42), and NTG (n = 40) and examined retrospectively. Blood samples (cTnI, N-terminal probrain natriuretic peptide [NT-proBNP], highly sensitive C-reactive protein [HsCRP], and others), left ventricular ejection fraction (LVEF), systolic pulmonary artery pressure (sPAP), and 6-minute walk distance (6MWD) were compared before and after treatment.
  
  
  RESULTS
  At admission, detectable levels of cTnI were observed in 53% of patients (≥0.05 ng/mL). Serial changes in the mean cTnI levels were not significantly different between the groups (LEV 0.04 ± 0.01 to 0.03 ± 0.01 ng/mL; DOB 0.145 ± 0.08 to 0.08 ± 0.03 ng/mL; NTG 0.1 ± 0.03 to 0.09 ± 0.02 ng/mL; overall P = .859). Favourable effects on the NT-proBNP, sPAP values, LVEF, 6MWD, and HsCRP were observed overall, especially in the LEV groups.
  
  
  CONCLUSIONS
  Beneficial effects of short-term use of LEV, DOB, and NTG on ongoing myocardial injury were demonstrated. These findings can be attributed to the anti-ischemic properties as well as the hemodynamic, neurohumoral, and functional benefits from the positive inotropes, especially LEV, in patients with ADHF.
authors.affiliation: 1 Department of Cardiology, Cardiology Clinic, Kilis State Hospital, Kilis, Turkey.
authors.forename: Erkan
authors.initials: E
authors.lastname: Gencer
authors.affiliation: 2 Department of Cardiology, Mugla Sıtkı Kocman University, Mugla, Turkey.
authors.forename: Volkan
authors.initials: V
authors.lastname: Doğan
authors.affiliation: 3 Department of Cardiology, Cardiology Clinic, Kecioren Education and Research Hospital, Ankara, Turkey.
authors.forename: Müjgan Tek
authors.initials: MT
authors.lastname: Öztürk
authors.affiliation: 4 Department of Cardiology, Cardiology Clinic, Bozuyuk State Hospital, Bilecik, Turkey.
authors.forename: Aydın
authors.initials: A
authors.lastname: Nadir
authors.affiliation: 5 Department of Biostatistics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Musmul
authors.affiliation: 6 Department of Cardiology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey.
authors.forename: Yüksel
authors.initials: Y
authors.lastname: Cavuşoğlu
keywords: dobutamine; heart failure; levosimendan; troponin