Effect of levosimendan in patients with acute decompensated heart failure : A meta-analysis

Acute decompensated heart failure (ADHF) is associated with high morbidity and mortality. Intravenous inotropic agents play an important role in treating ADHF. Relatively small clinical studies have evaluated the effects of levosimendan, a positive inotropic agent with calcium-sensitizing effects, in ADHF. The present meta-analysis pooled these studies to assess the clinical efficacy of levosimendan in ADHF.

The PubMed, MEDLINE, Cochrane Library, and ClinicalTrials.com databases were systematically searched for prospective clinical studies published in English up to May 2017 on effects of levosimendan alone or versus other agents (placebo [glucose], dopamine, furosemide) on left ventricular ejection fraction (LVEF), brain natriuretic peptide (BNP) level, and heart rate (HR) in patients with ADHF.

Seven articles were selected with 132 patients for levosimendan and 125 patients for control groups. Compared with controls (except dopamine) or after vs. before use, levosimendan was associated with a significantly reduced BNP level (standardized mean difference [SMD]: -0.70; 95% confidence interval [CI]: -0.92, -0.48; p = 0.000; I² = 22.0%), as well as improved LVEF (SMD: 0.47; 95%CI: 0.12, 0.81; p = 0.008; I² = 63.3%) and increased HR (SMD: 0.39; 95% CI: 0.15, 0.63; p = 0.002; I² = 23.6%) when comparing after vs. before use but not in comparisons to controls.

In the present meta-analysis, levosimendan infusion in patients with ADHF appeared to reduce BNP regardless of the comparator (except for dopamine), and also improve LVEF and increase HR in after vs. before use comparisons but not compared to controls. Future larger studies on the benefit of levosimendan in ADHF patients are warranted.