Key result
Levosimendan significantly improved NYHA functional class compared to dobutamine or placebo in patients with acute decompensated heart failure (OR 3.06; 95% CI 1.23-7.59; p=0.02).
Why the study?
Does a 24 h IV infusion of levosimendan improve NYHA class and clinical outcomes in patients with acute decompensated heart failure compared to dobutamine or placebo?
Meta-Analysis (n=2,747)
Does a 24 h IV infusion of levosimendan improve NYHA class and clinical outcomes in patients with acute decompensated heart failure compared to dobutamine or placebo?
Effect estimate: OR 3.06 (95% CI 1.23-7.59)
p-value: p=0.02
Levosimendan improves NYHA functional class, LVEF, and BNP levels in acute decompensated heart failure compared to dobutamine or placebo, but is associated with increased side effects.
Supports levosimendan for symptom relief in acute decompensated HF; reinforces Level 1 meta-analytic evidence versus dobutamine or placebo.
To assess the risks and benefits of levosimendan in acute decompensated heart failure compared to dobutamine or placebo. Pubmed, the Cochrane Central Register of Controlled Trials (CENTRAL), the European Heart Journal, and the Journal of the American College of Cardiology and Circulation were searched for randomized clinical trials of a 24 h IV infusion of levosimendan compared to dobutamine or a placebo in patients ≥18 years old admitted with a diagnosis of acute decompensated heart failure of any etiology with a NYHA class III and IV heart failure, a left ventricular ejection fraction <0.35, pulmonary catheter wedge pressure >15 mmHg or cardiac index <2.5 ml/min/m2. Eleven clinical trials (2747 patients) met the inclusion criteria for this review. Levosimendan was associated with a significant increase in NYHA class OR 3.06 (95% CI 1.23–7.59; p = 0.02), and a tendency to improve fatigue OR 1.80 1.53 (IC95% 0.99–2.39, p = 0.06) and clinical improvement composite OR 1.20 (IC95% 0.99–1.46; p = 0.06), as compared to dobutamine or a placebo. Levosimendan in acute decompensated heart failure improves NYHA functional class, LVEF and BNP levels when compared to dobutamine or a placebo, with an increase in side effects.
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Cornejo-Avendaño et al. (2017) conducted a meta-analysis in acute decompensated heart failure (n=2,747). Levosimendan vs. dobutamine or placebo was evaluated on increase in NYHA class (OR 3.06, 95% CI 1.23-7.59, p=0.02). Levosimendan significantly improved NYHA functional class compared to dobutamine or placebo in patients with acute decompensated heart failure (OR 3.06; 95% CI 1.23-7.59; p=0.02).
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