Терапевтический архив (Jun 2011)
Efficacy of levosimendan vs dopamine in patients with resistant cardiac failure
Abstract
Aim. Effects of levosimendan treatment compared to dopamine treatment on a clinical course, central hemodynamics and prognosis in patients with resistant cardiac failure (RCF). Material and methods. A total of 30 RCF patients (16 females and 14 males aged 50-80 years) were divided into two groups. Patients of group 1 received inotropic drug levosimendan intravenously in the initial dose 12-24 mcg/kg for 10 min with subsequent 24-hour infusion in a dose 0.1 mcg/kg/min. Patients of group 2 received dopamine intravenously for 24 hours in a mean dose 2.2 mcg/kg/min. The patients were followed up for 6 months. Results. In group 1 cardiac failure regressed earlier than in group 2. Left ventricular performance index after infusion hour 1 increased from 2.9 to 3.3 (kg.m)/m2, in group 2 it decreased from 2.6 to 2.3 (kg.m)/m2; p = 0.028). To infusion hour 24 this index in group 1 was 3.2 (kg.m)/m2, in group 2 - 2.6 (kg.m)/m2. Cardiac index (CI) in group 1 increased from 2.3 l/min/m2 at infusion min 1 to 2.7 l/min/ m2 after 10 min of infusion and 2.9 l/min/m2 after 24 hours, i.e. there was a 26% rise (p = 0.025). In group 2 the CI rise was insignificant - from 2.4 to 2.5 l/min/m2. To the end of levosimendan injection, systemic vascular resistance fell from 1520.9 to 1174.6 dyne.s.cm-5 (p = 0.031), in group 2 no significant changes were seen. Hospital mortality in group 1 was 1 patient, in group 2 - 6 patients. Conclusion. Inotropic treatment in RCF patients with levosimendan vs dopamine produces earlier regress of cardiac failure symptoms, better improvement of myocardial contractivity, is associated with a good prognosis.
