Effectiveness of Therapy with Levosimendan Versus Dobutamine in Acute Heart Failure: A Randomized Controlled Trial

  • Subrata Ray Assistant Chief Medical Officer, Department of Health, Government of West Bengal, M. R. Bangur Hospital, 241, Deshapran Sasmal Road, Tollygunge, Kolkata, West Bengal – 700033, India
  • Amal Kannti Das Ex Professor and HOD, Department of Pharmacology ,Jipmer , Kolkata.
  • Achyut Sarkar Associate Professor, Department of Cardiology, Jipmer, Kolkata.
  • Avijit Hazra Professor, Department of Pharmacology and Dean, Jipmer, Kolkata.
Keywords: Acute heart failure, Levosimendan and Dobutamine, Pharmacological intervention, Echocardiographic parameters; Randomized controlled trial


Background: Acute heart failure (AHF) is defined as the rapid onset of symptoms and signs secondary to cardiac dysfunction. Dobutamine is an established positive inotropic drug used in AHF with prompt action, most useful in heart failure complicated with hypotension. Levosimendan, another inotropic agent, has been shown to increase calcium sensitivity of Troponin C (TropC) of myofilaments by a novel mechanism and to inhibit phosphodiesterase III activity in myocardium. The present study was attempted to know the effectiveness of levosimendan with dobutamine in the management of AHF, as add-on to standard treatment.

Methods: In present study, 40 AHF patients were randomly selected those who were admitted to intensive coronary care unit (ICCU). A head-to-head comparison was carried out between levosimendan and dobutamine administered to AHF patients in addition to other existing drugs as a parallel group, open label, randomized controlled trial. Dosing was as per standard recommendation with infusion of each drug being continued for up to 48hrs. Subjects were assessed at baseline, and then at 24hrs, 1 week and 4 weeks. The primary outcome measures were change of heart rate, blood pressure, cardinal clinical features (dyspnea, orthopnea and crepitations), and 24hrs urine output. The secondary outcomes were changes in left ventricular ejection fraction (LVEF), LV end diastolic volume (LVEDV) and plasma NT-ProBNP. Treatment emergent adverse events were captured.

Results: Among 40 patients recruited 35 could complete the study. Both Dobutamine and Levosimendan provided symptom relief within 24hrs; heart rate declined, blood pressure and urine output improved along with improvement of echocardiographic parameters. NT-Pro BNP also declined in both groups. Although statistically significant differences were observed at some time points, and symptom relief was better in Levosimendan arm, no clear differences in LVEF and NT-pro BNP were observed. LVEDV reduction was arguably better in the Levosimendan arm.

Conclusion: In conclusion, Levosimendan can be considered as a therapeutic option in AHF but cannot be considered as a substitute for Dobutamine.



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1. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016;18:891-975.
2. Nohria A, Tsang SW, Fang JC, Lewis EF, Jarcho JA, et al. Clinical assessment identifies hemodynamic profiles that predict outcomes in patients admitted with heart failure. J Am Coll Cardiol. 2003;41:1797-1804.
3. Stevenson LW. Design of therapy for advanced heart failure. Eur J Heart Fail. 2005;7:323-31.
4. Killip T, 3rd, Kimball JT. Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients. Am J Cardiol. 1967;20:457-64.
5. Forrester JS, Diamond GA, Swan HJ. Correlative classification of clinical and hemodynamic function after acute myocardial infarction. Am J Cardiol. 1977;39:137-45.
6. Berg RA, Padbury JF, Donnerstein RL, Klewer SE, Hutter JJ Jr. Dobutamine pharmacokinetics and pharmacodynamics in normal children and adolescents. J Pharmacol Exp Ther. 1993;265:1232-8.
7. Hasenfuss G, Pieske B, Castell M, Kretschmann B, Maier LS, et al. Influence of the novel inotropic agent levosimendan on isometric tension and calcium cycling in failing human myocardium. Circulation. 1998;98:2141-7.
8. Kasikcioglu HA, Cam N. A review of levosimendan in the treatment of heart failure. Vascular Health Risk Manage. 2006;2:389-400.
9. Packer M, Colucci W, Fisher L, Massie BM, Teerlink JR, et al. Effect of levosimendan on the short-term clinical course of patients with acutely decompensated heart failure: randomized controlled trial. JACC Heart Fail. 2013;1(2):103-11.
10. Mebazaa A, Nieminen MS, Packer M, Cohen-Solal A, Kleber FX, et al. Levosimendan versus dobutamine for patients with acute decompensated heart failure: the SURVIVE Randomized Trial. J Am Med Assoc. 2007;297:1883-91.
11. Follath F, Cleland J, Just H, Papp J, Scholz H, et al. Efficacy and safety of intravenous levosimendan compared with dobutamine in severe low-output heart failure (the LIDO study): a randomised double-blind trial. Lancet. 2002;360:196-202.
12. Kivikko M, Pollesello P, Tarvasmäki T, Sarapohja T, Nieminen M, et al. Effect of baseline characteristics on mortality in the SURVIVE trial on the effect of levosimendan vs dobutamine in acute heart failure: Sub-analysis of the Finnish patients. Int J Cardiol. 2016;215:26-31.
13. Zairis M. Comparison of the effect of levosimendan, or dobutamine or placebo in chronic low output decompensated heart failure. CAlcium sensitizer or Inotrope or NOne in low output heart failure (CASINO) study. Eur J Heart Fail Supplements. 2004;3:66.
How to Cite
Ray S, Das AK, Sarkar A, Hazra A. Effectiveness of Therapy with Levosimendan Versus Dobutamine in Acute Heart Failure: A Randomized Controlled Trial. Int Arch BioMed Clin Res [Internet]. 2020Dec.30 [cited 2021Jan.26];6(4):PH4-PH10. Available from: http://iabcr.org/index.php/iabcr/article/view/642