Effect of Levosimendan on Ventricular Systolic and Diastolic Functions in Heart Failure Patients: A Meta-Analysis of Randomized Controlled Trials

Long, Yuxiang; Cui, Diyu; Kuang, Xue; Hu, Shuang; Hu, Yue; Liu, Zengzhang

doi:10.1097/fjc.0000000000001010

Cited by 6 publications

(7 citation statements)

References 48 publications

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“…Although the echocardiographic data and hemodynamic effects of levosimendan have been previously shown in patients with acute HF hospitalized and treated in acute cardiac settings (see recent meta-analysis by Long et al 12 ), the same has not previously been demonstrated for patients with advanced HF who are not in acute hemodynamic imbalance.…”

Section: Discussionmentioning

confidence: 92%

Hemodynamic Effects of Levosimendan in Outpatients With Advanced Heart Failure: An Echocardiographic Pilot Study

Masarone

Melillo

Errigo

et al. 2022

Journal of Cardiovascular Pharmacology

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Infusions of levosimendan delivered in ambulatory/ outpatient settings have been shown to improve quality of life and reduce hospitalizations in patients with advanced heart failure (HF). The aim of this pilot study was to evaluate the effects of ambulatory infusion of levosimendan on echocardiographic markers of perfusion, congestion, and cardiovascular efficiency. Thirty patients with diagnosed advanced HF underwent ambulatorial infusion of levosimendan at a total dose of 6.25 mg as a part of a repetitive biweekly treatment strategy with the inotrope. Standardized transthoracic echocardiography and Doppler examinations, were performed 1 hour before and 48 hours after completion of ambulatory infusion. At 48 hours after ambulatory infusion of levosimendan, a significant increase in the stroke volume (37.47 6 12.38 mL/beat vs. 45.47 6 14.48 mL/beat; P , 0.05) and cardiac output (2.64 6 0.66 L/min vs. 3.26 6 0.57 L/min; P , 0.05) occurred. Significant postreductions versus prereductions were also recorded in left atrial pressure (27.37

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Section: Discussionmentioning

confidence: 92%

Hemodynamic Effects of Levosimendan in Outpatients With Advanced Heart Failure: An Echocardiographic Pilot Study

Masarone

Melillo

Errigo

et al. 2022

Journal of Cardiovascular Pharmacology

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“…Levosimendan, a commonly used positive inotropic drug in heart failure, has been shown in previous meta-analyses to significantly improve ventricular systolic and diastolic function in patients with heart failure. [111][112][113] It is still unclear whether levosimendan treatment has an impact on ventricular remodelling. Various indicators can be used to assess ventricular remodelling, 114 such as cardiac size, shape, mass, and end-diastolic and end-systolic volumes.…”

Section: Discussionmentioning

confidence: 99%

Effect of levosimendan on ventricular remodelling in patients with left ventricular systolic dysfunction: a meta‐analysis

Wang,

Zhao,

Wang

et al. 2024

ESC Heart Failure

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Heart failure is the final stage of several cardiovascular diseases, and the key to effectively treating heart failure is to reverse or delay ventricular remodelling. Levosimendan is a novel inotropic and vasodilator agent used in heart failure, whereas the impact of levosimendan on ventricular remodelling is still unclear. This study aims to investigate the impact of levosimendan on ventricular remodelling in patients with left ventricular systolic dysfunction. Electronic databases were searched to identify eligible studies. A total of 66 randomized controlled trials involving 7968 patients were included. Meta‐analysis results showed that levosimendan increased left ventricular ejection fraction [mean difference (MD) = 3.62, 95% confidence interval (CI) (2.88, 4.35), P < 0.00001] and stroke volume [MD = 6.59, 95% CI (3.22, 9.96), P = 0.0001] and significantly reduced left ventricular end‐systolic volume [standard mean difference (SMD) = −0.52, 95% CI (−0.67, −0.37), P < 0.00001], left ventricular end‐diastolic volume index [SMD = −1.24, 95% CI (−1.61, −0.86), P < 0.00001], and left ventricular end‐systolic volume index [SMD = −1.06, 95% CI (−1.43, −0.70), P < 0.00001]. In terms of biomarkers, levosimendan significantly reduced the level of brain natriuretic peptide [SMD = −1.08, 95% CI (−1.60, −0.56), P < 0.0001], N‐terminal pro‐brain natriuretic peptide [SMD = −0.99, 95% CI (−1.41, −0.56), P < 0.00001], and interleukin‐6 [SMD = −0.61, 95% CI (−0.86, −0.35), P < 0.00001]. Meanwhile, levosimendan may increase the incidence of hypotension [risk ratio (RR) = 1.24, 95% CI (1.12, 1.39), P < 0.0001], hypokalaemia [RR = 1.57, 95% CI (1.08, 2.28), P = 0.02], headache [RR = 1.89, 95% CI (1.50, 2.39), P < 0.00001], atrial fibrillation [RR = 1.31, 95% CI (1.12, 1.52), P = 0.0005], and premature ventricular complexes [RR = 1.86, 95% CI (1.27, 2.72), P = 0.001]. In addition, levosimendan reduced all‐cause mortality [RR = 0.83, 95% CI (0.74, 0.94), P = 0.002]. In conclusion, our study found that levosimendan might reverse ventricular remodelling when applied in patients with left ventricular systolic dysfunction, especially in patients undergoing cardiac surgery, decompensated heart failure, and septic shock.

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“…In the patients with decompensated status requiring inotropes or intravenous diuretics, levosimendan may improve diastolic and systolic functions of both ventricles, but the benefits of hard endpoints, including hospitalizations and mortality, are contradictory [ 25 , 26 ]. In a randomized study on CV surgery, there was the trend of better outcomes upon use of levosimendan as compared to placebo use; however, significantly better outcomes were observed only in the subgroup of patients who underwent isolated coronary artery bypass graft surgery [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Section: Levosimendan For Adhfmentioning

confidence: 99%

Levosimendan Administration May Provide More Benefit for Survival in Patients with Non-Ischemic Cardiomyopathy Experiencing Acute Decompensated Heart Failure

Lee

Fang

et al. 2022

JCM

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Background: Acute decompensated heart failure (ADHF) is a life-threatening condition with a high mortality rate. Levosimendan is an effective inotropic agent used to maintain cardiac output and a long-lasting effect. However, only few studies have compared the clinical outcomes, after levosimendan therapy, among etiologies of ADHF. Methods: Between July 2014 and December 2019, 184 patients received levosimendan therapy for ADHF at our hospital. A total of 143 patients had ischemic cardiomyopathy (ICM), and 41 patients had non-ICM (NICM). Data on comorbidities, echocardiographic findings, laboratory findings, use of mechanical devices, consumption of other inotropic or vasopressor agents, frequency of HF hospitalization, cardiovascular (CV) mortality, and all-cause mortality were compared between the ICM and NICM groups. Results: Patients with ICM were older with higher prevalence of diabetes mellitus when compared to patients with NICM. Patients with NICM had a poorer left ventricular ejection fraction (LVEF) and higher left ventricular end-systolic volume when compared to patients with ICM. At the 30 day follow-up period, a lower CV mortality (ICM vs. NICM: 20.9% vs. 5.1%; log-rank p = 0.033) and lower all-cause mortality (ICM vs. NICM: 28.7% vs. 9.8%; log-rank p = 0.018) was observed in the NICM patients. A significantly lower all-cause mortality was noted at 180 day (ICM vs. NICM: 39.2% vs. 22.0%; log-rank p = 0.043) and 1 year (ICM vs. NICM: 41.3% vs. 24.4%; log-rank p = 0.046) follow up in the NICM subgroup. NICM (hazard ratio (HR): 0.303, 95% confidence interval (CI): 0.108–0.845; p = 0.023) and ECMO use (HR: 2.550, 95% CI: 1.385–4.693; p = 0.003) were significant predictors of 30 day all-cause mortality. Conclusions: In our study on levosimendan use for ADHF patients, better clinical outcomes were noted in the NICM population when compared to the ICM population. In the patients with cardiogenic shock or ventilator use, significantly lower incidence of 30 day mortality presented in the NICM population when compared with the ICM population.

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Effect of Levosimendan on Ventricular Systolic and Diastolic Functions in Heart Failure Patients: A Meta-Analysis of Randomized Controlled Trials

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 6 publications

References 48 publications

Hemodynamic Effects of Levosimendan in Outpatients With Advanced Heart Failure: An Echocardiographic Pilot Study

Hemodynamic Effects of Levosimendan in Outpatients With Advanced Heart Failure: An Echocardiographic Pilot Study

Effect of levosimendan on ventricular remodelling in patients with left ventricular systolic dysfunction: a meta‐analysis

Levosimendan Administration May Provide More Benefit for Survival in Patients with Non-Ischemic Cardiomyopathy Experiencing Acute Decompensated Heart Failure

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