• Hamza Duygu, Filiz Ozerkan, Sanem Nalbantgil, Mehdi Zoghi, Azem Akilli, Mustafa Akin, Cem Nazli, and Oktay Ergene.
• Int. J. Cardiol. 2008 Jan 11;123(2):201-3.

BackgroundLevosimendan is a novel positive inotropic calcium sensitizer agent used in acute heart failure. In acute heart failure, it improves hemodynamic parameters more favorably than the conventional positive inotropes. In this study, the effect levosimendan on E/E' ratio as a non-invasive indicator of LV filling pressure was evaluated compared to dobutamine in a prospective, randomized, patient-blind manner.MethodsPatients with an LVEF < 40% admitting with acute heart failure attack with ischemic origin were included to this study. Patients were randomized to levosimendan (n=30, mean age: 64+/-10 years, 63% male) or dobutamine (n=32, mean age: 66+/-8 years, 54% male) groups. The ratio of the peak E wave velocity taken from mitral inflow with PW Doppler to the peak E' wave velocity taken from mitral lateral annulus with tissue Doppler was determined. Pre-treatment and 24-hour after the treatment E/E' ratios were calculated and then compared in both groups.ResultsAge, gender, concomitant medications were similar in both groups (p>0.05). There was no difference for pre-treatment baseline E/E' ratios between levosimendan and dobutamine groups (15.7+/-4.0 vs 15.2+/-7.5 respectively, p=0.1). There were significant reductions in post-treatment E/E' ratios in levosimendan (15.7+/-4.0 vs 9.3+/-2.8, p=0.01) and dobutamine groups (15.2+/-7.5 vs 12.9+/-5.6, p=0.04). However, the reduction in levosimendan group was greater compared to dobutamine group (p=0.01).ConclusionsLevosimendan causes a greater reduction of E/E' ratio compared to dobutamine in acute systolic left heart failure. This may explain the more favorable hemodynamic effects of levosimendan when compared to conventional positive inotropics in patients with systolic left heart failure.

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