Clinical Outcomes in Acute Decompensated Heart Failure Patients with Reduced Ejection Fraction and Impaired Renal Function–A Study Comparing Levosimendan and Dobutamine

Abstract

Background: Cardiorenal syndrome is a disorder in which renal function is affected by heart failure (HF) or vice versa. It occurs in 20% of HF patients. The most common reason for hospitalization is acute decompensation (ADHF). Diuretics and inodilators are the standard of treatment in the management. Our objective was to demonstrate that levosimendan is more effective than dobutamine in improving the outcome of ADHF patients with a low ejection fraction (EF) and impaired kidney function. Material and methods: The study was carried out between January to December 2022. Patients with ADHF, a low EF (<40%) on echocardiography, and decreased renal function (estimated glomerular filtration rate [eGFR] >15 and <60 mL/min/m 2 ) were included. All patients have given consent. The study was approved by the institutional ethical committee. The estimated study sample size was 18 in each group, and as the study continued, we enrolled 60 patients, who were divided into two equal groups (30 in each). The patients were assigned either levosimendan or dobutamine based on preassigned numbers in the software. The clinical characteristics (serum creatinine, eGFR, EF, cardiac output, and cardiac index) were measured on the first, seventh, and at one month (30 days). Results: Of the 60 patients, 40 were men and 20 were women. The mean age was (50 ± 8.9 vs 50.8 ± 11.2) years. Of the comorbidities, hypertension was seen in 83.3% followed by diabetes (56.7%). Serum creatinine levels in both groups at admission and 30 days were (2.2 ± 0.3 vs. 2.5 ± 0.7, P = 0.1) and (1.6 ± 0.4 vs. 2.4 ± 0.8, P = 0.05). The eGFR of both groups at admission and 30 days follow up was (32.6 ± 9.1 vs. 28.2 ± 11.4, P = 0.2) and (40 ± 15.5 vs. 29.4 ± 12.6, P = 0.05). At 30 days, the predetermined outcomes in terms of improvement in EF, cardiac output, improved eGFR and cardiac index were better in the levosimendan compared to dobutamine group significantly. Conclusion: In ADHF patients with decreased EF and poor renal function, levosimendan improved renal and cardiac indices more than dobutamine at 30 days of follow up.