529 Levosimendan versus dobutamine in patients with moderate to severe right ventricular dysfunction on top of severe left ventricular failure

Abstract

Poor RV function is a prognostic marker for mortality in patients with severe HF. We compared Levosimendan (L) versus Dobutamine (D) in patients with significant RV dysfunction (RVD) on top of severe left HF. Forty consecutive patients, with systolic HF and having moderate-tosevere RVD were randomized to L and D in a 2:1 fashion. Two groups were comparable in degree of RVD, EF, SPAP and creatinine values at baseline. After the infusion, EF improved, SPAP decreased significantly in both groups. TAPSE, having an independent prognostic role in HF, and RVFAC were improved significantly in patients with L compared to patients with D (Table 1). Furthermore, L improved both 24-hour urine output and creatinine, whereas, D did only small, but significant, improvement in urine output without in the creatinine levels. On the other hand, mean time period of hospitalization was significantly less in the L arm compared to D arm (9±1.8 vs. 11.3±3.1 days, p=0.024) with less requirement for intravenous loop diuretic (total dose divided by number of days of hospitalization) during the hospitalization period (mean intravenous dose per day 44mg vs. 72 mg, p=0.003). Furthermore, hospitalization period was negatively correlated with the percent change in 24-hour urine output in all group (r= -0.573, p=0.007).