Levosimendan Can Improve the Level of B-Type Natriuretic Peptide and the Left Ventricular Ejection Fraction of Patients with Advanced Heart Failure: A Meta-analysis of Randomized Controlled Trials

Cui, Diyu; Liao, Yimeng; Li, Gege; Chen, Yunqing

doi:10.1007/s40256-020-00416-y

Cited by 13 publications

(17 citation statements)

References 35 publications

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“…Treatment with the calcium sensitizer levosimendan was associated with an increase in ejection fraction. This has also been demonstrated previously [9,29]. In the present study, the mean change in ejection fraction was + 7%.…”

Section: Discussionsupporting

confidence: 92%

Association of Repetitive Dosing of Levosimendan with Reduction of NYHA Class and NT-proBNP Levels in Decompensated Heart Failure: A Retrospective Cohort Study

Wechsler

Schwinger

2022

Drugs - Real World Outcomes

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Background There is evidence that repetitive administration of levosimendan can improve outcome in chronic heart failure patients. Objective The aim of this retrospective study was to investigate the effect of therapy with levosimendan (LEV) additional to standard medical care in patients with symptomatic heart failure (HFrEF = heart failure with reduced ejection fraction) on NYHA class, NT-proBNP values, ejection fraction (EF) and body weight. Patients and Methods 178 participating patients (125 male, 53 female; mean age of 73 ± 13 years) were grouped according to whether LEV was given once (group 1) or repetitively (group 2). In group 2 data were analysed for first treatment with LEV (group 2a) and for the following repetitive LEV treatments (group 2b). The differentiation was required to see if there were different results for the particular groups. Results Repetitive dosing was given between two and 11 times, leading to 47 repetitive applications of LEV and a total of 225 (178 once + 47 repetitive) applications. The mean time between the repetitive dosing was 133 days or 4.3 months. LEV in addition to standard medical treatment was associated with reduction of NT-proBNP levels from 9138 to 7051 pg/mL ( p < 0.05). The corresponding values in group 2a and group 2b were 8790–4717 pg/mL ( p < 0.05) as well as 13,681–7581 pg/mL ( p < 0.05). The ejection fraction measured by echocardiography improved from 30 to 38% in group 1, from 31 to 45% in group 2a and from 30 to 35% in group 2b ( p < 0.05). Addition of LEV was associated with significant reduction of NYHA class and bodyweight in all groups. No adverse side effects (e.g., rhythm disorder, hypotension, electrolyte disorder) were seen. Conclusion LEV may be useful as an additive to standard care of treatment for patients with acute de novo decompensation due to acute heart failure as well as to prevent further deterioration in patients with chronic heart failure disease at high risk for hospitalisation. Intraindividual changes in NT-proBNP levels may be useful in decision-making about the need for additional treatment options in patients with worsening heart failure.

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Section: Discussionsupporting

confidence: 92%

Association of Repetitive Dosing of Levosimendan with Reduction of NYHA Class and NT-proBNP Levels in Decompensated Heart Failure: A Retrospective Cohort Study

Wechsler

Schwinger

2022

Drugs - Real World Outcomes

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“…It is speculated that AHF patients with higher eGFR had more comorbidities, more severe of AHF defined by NYHA or Killip classification and degree of dyspnea, which influences the treatment and outcomes ( 2 ). Furthermore, we found that levosimendan infusion could reduce BNP or NT-pro BNP levels in overall population as previous studies ( 17 ). In subgroup analysis, the difference of BNP levels between pre- and post- levosimendan infusion was non-significant among patients with eGFR lower than 30 ml/min/m 2 , it's might because few patients had examined BNP levels in this eGFR category.…”

Section: Discussionsupporting

confidence: 88%

Impact of levosimendan on efficacy and renal function in acute heart failure according to renal function: A perspective, multi-center, real-world registry

Zhang

Jiang²,

Fu³

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveAcute heart failure (AHF) is associated with high mortality. Levosimendan, an inodilator, has proved to increase cardiac output and exert renoprotective effect in AHF. Our aim was to investigate the efficacy and renoprotective effects of levosimendan in patients with AHF and different renal function.MethodsThis is a prospective, observational, multi-center registry. Patients admitted with AHF between June 2020 and May 2022 and treated with levosimendan during the hospital stay were included. Baseline characteristics, laboratory tests, electrocardiogram (ECG), chest X-ray, echocardiography, and treatment were collected. A 5-point Likert scale was used to document patients' baseline dyspnea. The estimated glomerular filtration rate (eGFR) was calculated by means of the Modification of Diet in Renal Disease equation. After levosimendan infusion, patients underwent assessment of degree of dyspnea, and levels of brain-type natriuretic peptide (BNP) /N-terminal pro-BNP (NT-pro BNP), and eGFR repeatedly.ResultsAmong 789 AHF patients who received levosimendan treatment in this study, 33.0 % were female, mean age was 64.9 ± 16.8 years, and mean eGFR was 72.6 ± 32.5 ml/min/m2. The mean score of dyspnea was 3.0 ± 1.0 using 5-point Likert scale before levosimendan infusion. Dyspnea improved in 68.7% patients at 6h after infusion of levosimendan, and in 79.5% at 24 h. Lower eGFR was associated with lower efficacy rate after 6h infusion (71.7, 70.7, 65.2, and 66.0%, respectively) and after 24 h infusion (80.5, 81.4, 76.2, and 77.8%, respectively). The levels of BNP or NT-pro BNP were also decreased after levosimendan treatment, and in each eGFR category. Levels of eGFR increased from baseline (72.6 ± 32.5 ml/min/m2) to 12–24h (73.8 ± 33.5 ml/min/m2) and 24–72h (75.0 ± 33.4 ml/min/m2) after starting treatment (p < 0.001). However, the eGFR levels increased only in patients with eGFR lower than 90.0 ml/min/m2.ConclusionsIn AHF patients who received levosimendan, degree of dyspnea and levels of BNP or NT-pro BNP were significantly improved, especially in patients with higher eGFR levels. However, levosimendan infusion increase eGFR only in AHF patients with renal dysfunction.

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“…[ 32 ] (This effect has been corroborated in a meta-analysis of studies in AHF undertaken by Chinese investigators at Chongqing Medical University. [ 33 ]) Third, there were consistent benefits in symptom control with levosimendan. [ 28 , 30 ] However, there were mixed findings for hospitalisation and mortality: positive numerical trends were observed, but did not attain statistical significance.…”

Section: Clinical Experience With Levosimendanmentioning

confidence: 97%

“…For example, a meta-analysis of randomised controlled trials in patients with advanced HF by Cui et al, from Chongqing Medical University, has confirmed this effect of levosimendan and associated it with improvement in LVEF compared with placebo, dobutamine, furosemide and prostaglandin E 1 (standardised mean difference 0.74; 95% CI [0.22–1.25]; p=0.005). [ 33 ]…”

Section: Expert Assessmentmentioning

confidence: 99%

Levosimendan in Europe and China: An Appraisal of Evidence and Context

Kong

Hua

et al. 2021

Eur Cardiol

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The calcium sensitiser levosimendan (SIMDAX; Orion Pharma) has been in clinical use for the management of acute heart failure and a range of related syndromes in many countries around the world for two decades. More recently, levosimendan has become available in China. The authors have examined the profile of levosimendan in clinical trials conducted inside and outside China and grouped the findings under six headings: effects on haemodynamics, effects on natriuretic peptides, effect on symptoms of heart failure, renal effects, effect on survival, and safety profile. Their conclusions are that under each of these headings there are reasonable grounds to expect that the effects and clinical benefits established in trials and with wider clinical use in Europe and elsewhere will accrue also to Chinese patients. Therefore, the authors are confident that global experience with levosimendan provides a reliable guide to its optimal use and likely therapeutic effects in patients in China.

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Levosimendan Can Improve the Level of B-Type Natriuretic Peptide and the Left Ventricular Ejection Fraction of Patients with Advanced Heart Failure: A Meta-analysis of Randomized Controlled Trials

Cited by 13 publications

References 35 publications

Association of Repetitive Dosing of Levosimendan with Reduction of NYHA Class and NT-proBNP Levels in Decompensated Heart Failure: A Retrospective Cohort Study

Association of Repetitive Dosing of Levosimendan with Reduction of NYHA Class and NT-proBNP Levels in Decompensated Heart Failure: A Retrospective Cohort Study

Impact of levosimendan on efficacy and renal function in acute heart failure according to renal function: A perspective, multi-center, real-world registry

Levosimendan in Europe and China: An Appraisal of Evidence and Context

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