Introduction: Levosimendan has positive inotropic and vasodilatory actions resulting in increased contractile force, preload and afterload reduction, without adversely affecting the diastolic function, which makes it one of preferred inotropes in acute decompensated heart failure (ADHF). However, its use found to have conflicting results. Research Question or Hypothesis: Does levosimendan use in ADHF result in favorable effectiveness and safety in comparison to other inotrope(s)? Study Design: Retrospective cohort study Methods: We included all patients admitted with ADHF to the main tertiary cardiology center in Qatar during 6/2019 - 12/2022 and received inotrope(s) during the index admission. We divided the study population in two groups; (1) ADHF patients received levosimendan as a single agent or in combination with other inotrope(s); (2) ADHF patients who received other inotropic therapy, including dobutamine, noradrenaline, dopamine, or milrinone, either alone or in combination. Outcomes assessed were escalation to intra-aortic balloon pump (IABP), in-hospital mortality, 30-day mortality, inotrope induced-hypotension, and inotrope induced-arrhythmias. Chi-square test was used to compare outcomes between the two groups, and P-value <0.05 indicated statistical significance. Results: We found 161 patients eligible for inclusion; 45 received levosimendan and 116 received other inotrope(s). The majority of patients were male (85%), and the study population age was 59±15 years. More than 55% were Asian. Baseline demographics and disease-related characteristics were balanced between the arms except for ejection fraction which was significantly lower in the levosimendan group (29% ± 11 vs. 38% ± 13, P<0.001). All effectiveness outcomes were comparable between the two groups. However, hypotension and arrhythmias were significantly higher with levosimendan (hypotension: 20% vs. 8.6%, P=0.045; arrhythmias: 22.2% vs. 6.9%, P=0.006). Conclusion: Using real-world data, levosimendan demonstrated similar effectiveness compared to other inotropic therapy in ADHF with increased risk of hypotension and arrhythmias. Such findings might alert cardiologists to monitor for hypotension and arrhythmias upon using levosimendan.
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