Comparison of the effect of concomitant beta-blocking treatment on the symptomatic responses to levosimendan and dobutamine in patients with severe low-output heart failure

Abstract

Introduction: Levosimendan (LS), the novel calcium sensitizer, and dobutamine (DO), a beta-adrenoceptor agonist, have both been shown to improve clinical symptoms in patients with severe low-output heart failure (HF). However, patients with concomitant betablocking treatment showed greater hemodynamic improvement with LS whereas the opposite was seen with DO. We studied whether this observation was reflected in the symptomatic responses of patients. Methods: A multicentre, randomised, double-blind trial compared the hemodynamic and clinical effects of LS and DO infusions over 24h in patients with severe low-output HF (n = 203). Patients were given LS as an initial loading dose of 24 microg/kg over 10 minutes followed by a continuous infusion of 0.1 mg/kg/minute, or a continuous infusion of DO of 5 microg/kg/minute. The infusion rates were doubled if the cardiac index did not increase by at least 30% compared to baseline after 2h of treatment. Results: In LS-treated group, significantly more of patients treated with beta-blocking agents at baseline reported improvement in both dyspnea and global assessment compared to patients treated with DO (Table). The effects of DO were attenuated by the concomitant use of beta-blocking agents. Conclusions: These results support the concomitant use of LS with beta-blockers in the management of patients with severe low-output heart failure.