Russian Heart Failure Journal 2009year Comparative efficacy of levosimendan and dobutamine in improving major echocardiographic, hemodynamic and neuro-humoral parameters in patients with IHD and CHF

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Comparative efficacy of levosimendan and dobutamine in improving major
echocardiographic, hemodynamic and neuro-humoral parameters in patients with IHD and CHF

Rakhimov A. Z., Kamardinov D. Kh., Tugeeva E. F., Matskeplishvili S.T., Buziashvili Yu. I.



Urgency. A therapeutic strategy in patients with CHF should be focused on stabilization of their condition, improvement of prognosis and quality of life due to reduced symptoms and requirement of repeated hospitalizations. In this setting, non-glycoside inotropic drugs are mandatory. Thus the non-glycoside inotropic drug, the calcium sensitizer levosimendal is of a great practical interest. Aim. Studying clinical effects of levosimendan compared to a traditional non-glycoside drug, dobutamine as a part of multimodality treatment in patients with IHD and CHF. Materials and methods. 52 patients with IHD complicated with CHF and LV systolic dysfunction (LV EF <40%) were evaluated. Group 1 (n=27) included patients who received a single daily infusion of 12.5 mg levosimendan solution in addition to their drug therapy; group 2 (n=25) consisted of patients who received a single daily infusion of 750 mg dobutamine solution. General clinical examination, ECG, echoCG, and tetrapolar chest impedancemetry were performed and plasma level of brain natriuretic peptide (BNP) was measured in all patients. Patients were examined at baseline, 15 minutes after the beginning of drug infusion, at 3 days, 1, 3 and 5 months. Results. Levosimendan significantly improved the LV systolic function, hemodynamic parameters and decreased BNP levels. Compared to dobutamine, the effect of levosimendan persisted for a longer time. While the effect of dobutamine rapidly disappeared after the end of infusion (effects were not seen in 3 days) effects of levosimendan remained for at least 3 days and some of them remained up to 1 month. Levosimendan exerted a less potent but much more prolonged inotropic effect than dobutamine and was undoubtedly superior to dobutamine by vasodilation and duration of hemodynamic effects. Beneficial effects of levosimendan on the neuro-humoral profile of IHD patients with CHF are its definite advantage over dobutamine.
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