Levosimendan significantly improved right ventricular fractional area change (WMD 3.17%) and decreased systolic pulmonary arterial pressure compared to control in patients with heart dysfunction.
Meta-Analysis (n=390)
Does levosimendan improve right ventricular systolic function and pulmonary hemodynamics in patients with heart dysfunction?
Levosimendan improves right ventricular systolic function and decreases pulmonary artery pressure in patients with heart dysfunction, supporting its use as an inodilator for right heart failure.
Effect estimate: WMD 3.17% (95% CI 2.03-4.32)
p-value: p=<0.00001
Levosimendan exerts positive inotropic and vasodilatory effects. Currently, its effects on right heart function remain uncertain. This systematic review and meta-analysis is intended to illustrate the impacts of levosimendan on systolic function of the right heart in patients with heart dysfunction. We systematically searched electronic databases (PubMed, the Cochrane Library, Embase and Web of Science) up to November 30, 2020, and filtered eligible studies that reported the impacts of levosimendan on right heart function. Of these, only studies whose patients suffered from heart dysfunction or pulmonary hypertension were included. Additionally, patients were divided into two groups (given levosimendan or not) in the initial research. Then, RevMan5.3 was used to conduct further analysis. A total of 8 studies comprising 390 patients were included. The results showed that after 24 h of levosimendan, patients' right ventricular fractional area change 3.17, 95% CI (2.03, 4.32), P < 0.00001, tricuspid annular plane systolic excursion 1.26, 95% CI (0.35, 2.16), P = 0.007 and tricuspid annular peak systolic velocity 0.86, 95% CI (0.41, 1.32), P = 0.0002 were significantly increased compared to the control group. And there is an increasing trend of cardiac output in levosimendan group 1.06, 95% CI (- 0.16, 2.29), P = 0.09 .Furthermore, patients' systolic pulmonary arterial pressure - 5.57, 95% CI (- 7.60, - 3.54), P < 0.00001 and mean pulmonary arterial pressure - 1.01, 95% CI (- 1.64, - 0.37), P = 0.002 were both significantly decreased, whereas changes in pulmonary vascular resistance - 55.88, 95% CI (- 206.57, 94.82), P = 0.47 were not significant. Our study shows that in patients with heart dysfunction, levosimendan improves systolic function of the right heart and decreases the pressure of the pulmonary artery.
Hu et al. (Thu,) conducted a meta-analysis in Heart dysfunction (n=390). Levosimendan vs. Placebo, dopamine, or prostaglandin was evaluated on Right ventricular fractional area change (RVFAC) (WMD 3.17%, 95% CI 2.03-4.32, p=<0.00001). Levosimendan significantly improved right ventricular fractional area change (WMD 3.17%) and decreased systolic pulmonary arterial pressure compared to control in patients with heart dysfunction.