Περίληψη:
Aims: 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.
Methods and 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, 10
mg/kg/min, versus b) levosimendan, 0.3 mg/kg/min, versus c) dobutamine,
10mg/kg/min + levosimendan 0.2 mg/kg/min, each administered weekly, for
6 h, 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 3 months, 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. (c)
2011 Elsevier Ireland Ltd. All rights reserved.
Συγγραφείς:
Bonios, Michael J.
Terrovitis, John V.
Drakos, Stavros G. and
Katsaros, Fotis
Pantsios, Chris
Nanas, Serafim N.
Kanakakis,
John
Alexopoulos, George
Toumanidis, Savvas
Anastasiou-Nana,
Maria
Nanas, John N.
