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.

To assess the clinical impact of the combination dobutamine and levosimendan for the treatment of ADHF with low cardiac output.

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.

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).

Levosimendan added to dobutamine may improve the outcome of ADHF refractory to dobutamine alone.