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Effect of levosimendan in patients with acute decompensated heart failure

A meta-analysis
Review articles
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Abstract

Background

Acute decompensated heart failure (ADHF) is associated with high morbidity and mortality. Intravenous inotropic agents play an important role in treating ADHF. Relatively small clinical studies have evaluated the effects of levosimendan, a positive inotropic agent with calcium-sensitizing effects, in ADHF. The present meta-analysis pooled these studies to assess the clinical efficacy of levosimendan in ADHF.

Materials and methods

The PubMed, MEDLINE, Cochrane Library, and ClinicalTrials.com databases were systematically searched for prospective clinical studies published in English up to May 2017 on effects of levosimendan alone or versus other agents (placebo [glucose], dopamine, furosemide) on left ventricular ejection fraction (LVEF), brain natriuretic peptide (BNP) level, and heart rate (HR) in patients with ADHF.

Results

Seven articles were selected with 132 patients for levosimendan and 125 patients for control groups. Compared with controls (except dopamine) or after vs. before use, levosimendan was associated with a significantly reduced BNP level (standardized mean difference [SMD]: −0.70; 95% confidence interval [CI]: −0.92, −0.48; p = 0.000; I2 = 22.0%), as well as improved LVEF (SMD: 0.47; 95%CI: 0.12, 0.81; p = 0.008; I2 = 63.3%) and increased HR (SMD: 0.39; 95% CI: 0.15, 0.63; p = 0.002; I2 = 23.6%) when comparing after vs. before use but not in comparisons to controls.

Conclusion

In the present meta-analysis, levosimendan infusion in patients with ADHF appeared to reduce BNP regardless of the comparator (except for dopamine), and also improve LVEF and increase HR in after vs. before use comparisons but not compared to controls. Future larger studies on the benefit of levosimendan in ADHF patients are warranted.

Keywords

Natriuretic peptide, brain Inotropic agents Heart rate Calcium Clinical study 

Wirkung von Levosimendan bei Patienten mit akut dekompensierter Herzinsuffizienz

Metaanalyse

Zusammenfassung

Hintergrund

Die akut dekompensierte Herzinsuffizienz (ADHI) ist mit einer hohen Morbidität und Mortalität assoziiert. Intravenös applizierte Inotropika spielen eine wichtige Rolle in der Therapie der ADHI. In eher kleinen klinischen Studien wurden die Effekte von Levosimendan bei ADHI untersucht. Levosimendan wirkt durch Steigerung der Kalziumsensitivität positiv inotrop. Die vorliegende Metaanalyse führte diese Studien zusammen, um die klinische Wirksamkeit des Wirkstoffs bei ADHI zu ermitteln.

Material und Methoden

Die Datenbanken PubMed, MEDLINE, Cochrane Library und ClinicalTrials.com wurden systematisch nach prospektiven klinischen Studien durchsucht, die bis Mai 2017 auf Englisch erschienen und in denen die Effekte von Levosimendan allein oder im Vergleich zu anderen Substanzen (Placebo [Glukose], Dopamin, Furosemid) auf die linksventrikuläre Ejektionsfraktion (LVEF), den Spiegel des natriuretischen Peptids vom B‑Typ (BNP) und die Herzfrequenz (HF) bei Patienten mit ADHI untersucht wurden.

Ergebnisse

Sieben Beiträge mit 132 Patienten in der Levosimendan- und 125 Patienten in den Kontrollgruppen wurden ausgewählt. Im Vergleich zu Kontrollen (außer Dopamin) oder im Vorher-nachher-Vergleich bezüglich der Anwendung war Levosimendan mit einem signifikant reduzierten BNP-Spiegel assoziiert (standardisierte Mittelwertdifferenz [SMD]: −0,70; 95%-Konfidenzintervall [KI]: −0,92, −0,48; p = 0,000; I2 = 22,0%), zudem mit einer verbesserten LVEF (SMD: 0,47; 95%-KI: 0,12, 0,81; p = 0,008; I2 = 63,3%) und einer erhöhten HF (SMD: 0,39; 95%-KI: 0,15, 0,63; p = 0,002; I2 = 23,6%) im Vorher-nachher-Vergleich bezüglich der Anwendung, nicht aber im Vergleich zu Kontrollen.

Schlussfolgerung

In der vorliegenden Metaanalyse schien die Levosimendaninfusion bei Patienten mit ADHI BNP unabhängig von der Vergleichssubstanz (außer Dopamin) zu reduzieren. Zudem schien sie im Vorher-nachher-Vergleich, nicht aber im Vergleich zu Kontrollen die LVEF zu verbessern und die HF zu erhöhen. Größer angelegte Studien zum Nutzen von Levosimendan bei Patienten mit ADHI sind erforderlich.

Schlüsselwörter

Natriuretisches Peptid, B‑Typ Inotropika Herzfrequenz Kalzium Klinische Studie 

Notes

Compliance with ethical guidelines

Conflict of interest

S. Zhou, L. Zhang, and J. Li declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Cardiovascular MedicineSecond Affiliated Hospital to Nanchang UniversityNanchang of JiangxiChina
  2. 2.Department of AnesthesiologySecond Affiliated Hospital to Nanchang UniversityNanchang of JiangxiChina

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