Is levosimendan a breakthrough in the development of positive inotropes?

Abstract

In heart failure, positive inotropes that increase the heart’s energy requirements (digoxin, phosphodiesterase inhibitors and β-adrenoceptor agonists) either have no effect or increase mortality. Calcium sensitisers, including levosimendan, have minimal effects on myocardial energy requirements. In deteriorating severe heart failure, intravenous levosimendan and dobutamine (a β-adrenoceptor agonist) were compared and haemodynamic improvement (≥ 30% increase in cardiac output and ≥ 25% decrease in pulmonary-capillary wedge pressure) was more common with levosimendan than dobutamine. The effectiveness of dobutamine in some patients was probably limited by concurrent treatment with β-blockers. In the patients who were not receiving a β-blocker, 19 of 70 patients in the levosimendan group and 11 of 71 patients in the dobutamine group had haemodynamic improvement. Levosimendan may be more appropriate than dobutamine for the treatment of decompensated heart failure, especially given the growing use of β-blockers that may limit the effectiveness of dobutamine.

• decompensated heart failure
• dobutamine
• levosimendan