A clinical comparative study of levosimendan on patients with acutely heart failure / 中华急诊医学杂志

ABSTRACT

Objective To investigate the efficacy and safety of levosimendan on patients with acutely decompensated heart failure (ADHF).Methods A prospective randomized and controlled study was carried out from June 2013 to June 2014.Patients were randomly divided into levosimendan group and dobutamine group,with 60 patients in each group.All patients received an intravenous infusion of levosimendan or dobutamine for 24 hours.Brain natriuretic peptide (BNP),stroke volume (SV) and left ventricular ejection fraction (LVEF) were measured.The cardiovascular mortality,rehospitalization rate,the composite endpoint differences and the incidence of adverse events were compared between two groups in 1,3,6 months after treatment.Comparisons between two groups were made using Student t-test or one-way ANOVA.Statistical analysis was performed using SPSS 17.0 software and a P value of ＜ 0.05 was considered statistically significant.Results There was no significant difference in the basic characteristics between two groups.Compared with baseline level,the plasma BNP levels,SV and LVEF were improved at 24 h in both groups (P ＜ 0.05).The cardiac function indexes were better in levosimendan group than in dobutamine group at 24 h [BNP (1147±407) pg/mL vs.(1 502±501) pg/mL,SV (60.9±9.6) mL vs.(57.3±10.3) mL,LVEF (31.6±6.0)％ vs.(28.8±5.1)％,P＜0.05].One month later,the cardiac function indexes were still better in levosimendan group than baseline [BNP (796 ± 296) pg/mL vs.(1 951 ±692) pg/mL,SV (64.6±9.5) mL vs.(52.2±9.1) mL,LVEF (33.4 ±5.8)％ vs.(25.7 ± 6.1) ％,P ＜ 0.05].After l months of treatment,the composite endpoint in levosimendan group was significantly lower than dobutamine group (5％ vs.16.3％,P =0.043).There was a downward trend of mortality and rehospitalization rate in levosimendan group in six months follow-up (P ＞ 0.05).The incidence of side effects was no statistically significant between groups (both were 13.3％).Conclusions Levosimendan is superior to that of dobutamine in improving the hemodynamic status and prognosis in ADHF patients,and the adverse reaction of levosimendan is less.