Aim: To investigate the effect of a new inotropic drug, levosimendan compared with dobutamine on levels of brain natriuretic peptide (BNP), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-a), and malondialdehyde (MDA) in patients with severe decompensated heart failure. Methods and results: Twenty-nine consecutive patients (22 males and 7 females), mean age 70.5 F 9.9 years, with decompensated heart failure on standard medical therapy, were randomised to receive either a 24 h infusion of levosimendan (n = 15) or dobutamine (n = 14). Blood samples were drawn at baseline, 48 h and 5 days post infusion. Levosimendan produced a significant reduction in BNP compared to baseline, at both 48 h (744.1 F100 vs 1136.3 F 93.7 pg/ml, p = 0.04) and 5 days (446 F 119.3 vs 1136.3 F 93.7 pg/ml, p = 0.03), while IL-6 values decreased after 5 days (4.8 F 1.3 vs 8.6 F 1.5 pg/ml, p = 0.01). MDA levels were significantly lower 5 days after levosimendan compared to baseline (2.3 F 0.2 vs 3 F 0.3 AM, p = 0.01). TNF-a levels did not differ between the groups. The comparison of percentage alteration compared to baseline showed that BNP (À44.5 F 7.6% vs 4.8 F 18.7%, p = 0.025), MDA (À21.8 F 5.1% vs 14.9 F 8.5%, p = 0.001) and IL-6 (À38.8 F 12.5% vs 70.2 F 24%, p = 0.001) levels were significantly lower in the levosimendan group 5 days after treatment compared to the dobutamine group. Conclusions: Treatment with levosimendan in advanced decompensated heart failure exerts a beneficial hemodynamic, anti-inflammatory and antioxidant effect. These findings may give an insight into the favourable impact on mortality that levosimendan appears to have in published multicenter trials.

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