Abstract
BackgroundAcute heart failure is a life-threatening clinical condition. Levosimendan is an effective inotropic agent used to maintain cardiac output, but its usage is limited by the lack of evidence in patients with severely abnormal renal function. Therefore, we analyzed data of patients with acute heart failure with and without abnormal renal function to examine the effects of levosimendan.MethodsWe performed this retrospective cohort study using data from the Chang Gung Research Database (CGRD) of Chang Gung Memorial Hospital (CGMH). Patients admitted for heart failure with LVEF ≤ 40% between January 2013 and December 2018 who received levosimendan or dobutamine in the critical cardiac care units (CCU) were identified. Patients with extracorporeal membrane oxygenation (ECMO) were excluded. Outcomes of interest were mortality at 30, 90, and 180 days after the cohort entry date.ResultsThere were no significant differences in mortality rate at 30, 90, and 180 days after the cohort entry date between the levosimendan and dobutamine groups, or between subgroups of patients with an estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m2 and eGFR < 30 mL/min/1.73 m2 or on dialysis. The results were consistent before and after propensity score matching.ConclusionsLevosimendan did not increase short- or long-term mortality rates in critical patients with acute heart failure and reduced ejection fraction compared to dobutamine, regardless of their renal function. An eGFR less than 30 mL/min/1.73 m2 was not necessarily considered a contraindication for levosimendan in these patients.
Highlights
Acute heart failure is a life-threatening clinical condition
Previous studies have demonstrated a comparable effect on improving cardiac output in heart failure patients to dobutamine, and it may result in a greater improvement in glomerular filtration rate than dobutamine in patients with cardiorenal syndrome [6,7,8,9,10,11,12]
After matching, 102 and 567 patients with estimated glomerular filtration rate (eGFR) > 30 mL/ min/1.73 m2 were classified into the levosimendan and dobutamine groups, respectively, and 52 and 374 patients with eGFR ≤ 30 mL/min/1.73 m2 or dialysis were classified into the levosimendan and dobutamine groups (Fig. 1), respectively
Summary
Acute heart failure is a life-threatening clinical condition. We analyzed data of patients with acute heart failure with and without abnormal renal func‐ tion to examine the effects of levosimendan. Levosimendan is a Ca2+-sensitizer of the myocardium, which induces vasodilatation and increases cardiac output [2,3,4] It is effective in patients with acute decompensated heart failure by improving left ventricular ejection fraction (LVEF), decreasing B-type natriuretic peptide levels, improving renal function, and decreasing the need for renal replacement therapy in different settings [5]. The aim of this study was to analyze patients with AHF and reduced LVEF with or without abnormal renal function to examine the effects of levosimendan
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