Levosimendan added to dobutamine in acute decompensated heart failure refractory to dobutamine - 06/01/20
Résumé |
Introduction |
Randomised study showed that dobutamine and levosimendan have similar impact on outcome in acute decompensated heart failure (ADHF) but their combination had never been assessed.
Purpose |
To assess the clinical impact of the combination dobutamine and levosimendan for the treatment of ADHF with low cardiac output.
Methods |
The study retrospectively included 89 patients (61±15 years) admitted for ADHF requiring inotropic support. The first group included patients historically treated by dobutamine alone (dobutamine group, n=42) and the second those treated by dobutamine plus levosimendan if superior vena cava oxygen saturation (ScvO2) remained ≤60% after 3 days of dobutamine infusion (dobutamine-levosimendan group, n=47). The two groups were compared in terms of changes in ScvO2 and major cardiovascular events (MACE) at 6 months defined by death, heart transplantation or need for assistance.
Results |
The dobutamine and dobutamine plus levosimendan groups had similar baseline clinical characteristics with no difference for admission cardiac index (1.7±0.5 vs. 1.8±0.6L/min/m2), lactate level (3.3±3.0 vs. 3.0±2.1mM/L) and ScvO2 (49±7% vs. 50±9%). At day-3, the ScvO2 target value (>60%) was reached in 36% and 32% of patients in the dobutamine and dobutamine-levosimendan group, respectively. After adding levosimendan, 72% of the dobutamine-levosimendan-group reached the ScvO2 target value at dobutamine weaning. At six months, 42 (47%) patients experienced MACE (n=28 for death). MACE was less frequent in the dobutamine-levosimendan (32%) than in the dobutamine-group (64%, p=0.003). Independent variables associated with outcome were admission systolic blood pressure and dobutamine-levosimendan strategy (OR=0.44 [0.23-0.84], p=0.01) (Table 1, Fig 1).
Conclusion |
Levosimendan added to dobutamine may improve the outcome of ADHF refractory to dobutamine alone.
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Vol 12 - N° 1
P. 29 - janvier 2020 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.