Effects of Levosimendan on Left Atrial Functions in Patients with Ischemic Heart Failure

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With further progression of left ventricular (LV) dysfunction, the left atrial (LA) contribution to LV filling gradually decreases, and LA dysfunction deteriorates the decreased LV filling in patients with heart failure (HF). This study sought to investigate the effects of levosimendan on LA function in patients with HF. A total of 60 patients having acute decompensated HF with ischemic cardiomyopathy and LV ejection fraction (LVEF) < 40% were included in the study. Patients were randomized to levosimendan (n = 30) or to dobutamine (n = 30). Before and 24 h after treatment, LVEF, mitral inflow peak E and A wave velocity, E/A ratio, mitral lateral annulus peak Em wave velocity, E/Em ratio, LA volumes, and from the LA volumes the active emptying fraction (AEF), passive emptying fraction (PEF), and reservoir fraction (RF) were measured. All LA volumes were significantly reduced after levosimendan administration, but in the dobutamine group only minimal volume (Vmin) was reduced. Although AEF increased in both groups, the improvement of AEF was greater in the levosimendan group than in the dobutamine group (14% +/- 9% versus 2% +/- 1%, p = 0.001). The PEF (12% +/- 8% versus 21% +/- 6%, p = 0.04) and RF (23% +/- 4% versus 38% +/- 3%, p = 0.001) significantly increased after levosimendan administration, whereas these parameters did not change after dobutamine. In patients receiving levosimendan, there was a significant, positive correlation between PEF and Em (r = 0.475, p = 0.008), and there were significant negative correlations between PEF and E/Em (r = - 0.491, p = 0.006), and AEF and E/Em (r = - 0.654, p = 0.001). Left atrial functions respond better to levosimendan than to dobutamine in decompensated HF.