Key result
Levosimendan cuts mortality and improves LVEF vs milrinone or dobutamine in advanced HF.
Why the study?
Evidence regarding differences in the long-term safety and efficacy of intermittent, repeated, or continuous palliative inotropic therapy among patients with advanced heart failure needed synthesis.
Does intermittent, repeated, or continuous levosimendan reduce mortality and improve left ventricular ejection fraction compared to milrinone or dobutamine in adult patients with advanced heart failure?
Meta-Analysis (n=5,137)
Does intermittent, repeated, or continuous levosimendan reduce mortality and improve left ventricular ejection fraction compared to milrinone or dobutamine in adult patients with advanced heart failure?
In patients with advanced heart failure requiring palliative inotropic therapy, levosimendan may offer mortality and LVEF benefits over milrinone or dobutamine, though it is associated with more frequent hypotension.
Answers are grounded in this paper and cite their sources.
Supports levosimendan preference in advanced HF despite hypotension risk; confirms benefits in RCT network meta-analysis.
The aim of this study was to synthesize the available evidence regarding differences in the long-term safety and efficacy of intermittent, repeated, or continuous palliative inotropic therapy among patients with advanced heart failure. We systematically searched the PubMed, Embase, and Cochrane Library electronic databases, with a cutoff date of November 23, 2023, for studies reporting outcomes in adult patients with advanced heart failure treated with intermittent, repeated, or continuous levosimendan, milrinone, or dobutamine. Forty-one studies (18 randomized controlled trials and 23 cohort studies) comprising 5137 patients met the inclusion criteria. The results of the network meta-analysis of randomized controlled trials showed that levosimendan had significant advantages over milrinone or dobutamine in reducing mortality and improving left ventricular ejection fraction. A single-arm meta-analysis also indicated that levosimendan had the lowest mortality and significantly improved B-type brain natriuretic peptide and left ventricular ejection fraction. Regarding safety, hypotension events were observed more frequently in the levosimendan and milrinone groups. However, the current evidence is limited by the heterogeneity and relatively small sample size of the studies.
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Zhang et al. (2024) conducted a meta-analysis in advanced heart failure (n=5,137). Levosimendan vs. Milrinone or dobutamine was evaluated on Mortality. Levosimendan significantly reduced mortality and improved left ventricular ejection fraction compared to milrinone or dobutamine in patients with advanced heart failure.
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