26651
document
Effects of levosimendan versus dobutamine on inflammatory and apoptotic pathways in acutely decompensated chronic heart failure . A single levosimendan administration has recently been shown to result in clinical and hemodynamic improvement in patients with decompensated heart failure ( HF ) , but without survival benefits . In this study , the effects of levosimendan and dobutamine on plasma levels of proinflammatory and proapoptotic mediators in decompensated HF were compared and correlated with the concomitant effects on cardiac function and prognosis . Sixty-nine patients were randomized to received 24-hour intravenous infusions of levosimendan ( n = 23 ) , dobutamine ( n = 23 ) , or placebo ( n = 23 ) . Echocardiographic , hemodynamic , and biochemical assessments were performed at baseline , immediately after treatment , and 48 hours later . Patients were subsequently followed for 4 months for disease progression . End-systolic wall stress , the left ventricular ejection fraction , pulmonary capillary wedge pressure , and cardiac index were significantly improved in the levosimendan group but remained practically unaffected in the other groups . Plasma N-terminal-pro-B-type natriuretic peptide , tumor necrosis factor-alpha , and soluble Fas ligand levels were significantly decreased only in the levosimendan group ( from 1,900 +/- 223 to 1,378 +/- 170 pg/ml , 13.4 +/- 1.0 to 12.3 +/- 1.2 pg/ml , and 68.2 +/- 3.7 to 59.8 +/- 3.6 pg/ml , respectively ; p < 0.05 for all ) ; interleukin-6 was also borderline reduced ( p = 0.051 ) . Levosimendan-induced reduction in end-systolic wall stress was significantly correlated with respective decreases in N-terminal-pro-B-type natriuretic peptide ( r = 0.671 , p < 0.01 ) , tumor necrosis factor-alpha ( r = 0.586 , p < 0.01 ) , soluble Fas ( r = 0.441 , p < 0.05 ) , and soluble Fas ligand ( r = 0.614 , p < 0.01 ) . Event-free survival was significantly longer in the levosimendan group ( p < 0.05 ) . In conclusion , the superiority of levosimendan over dobutamine in improving central hemodynamics and left ventricular performance in decompensated HF seems to be related to its anti-inflammatory and antiapoptotic effects .
26652
Intervention_Pharmacological
levosimendan
26653
Intervention_Pharmacological
dobutamine
26654
Intervention_Pharmacological
levosimendan
26655
Intervention_Pharmacological
levosimendan
26656
Intervention_Pharmacological
dobutamine
26657
Intervention_Pharmacological
levosimendan
26658
Intervention_Pharmacological
dobutamine
26659
Intervention_Control
placebo
26660
Intervention_Pharmacological
levosimendan
26661
Intervention_Pharmacological
levosimendan
26662
Intervention_Pharmacological
levosimendan
26663
Intervention_Pharmacological
dobutamine
26664
Outcome_Physical
Echocardiographic , hemodynamic , and biochemical assessments
26665
Outcome_Physical
End-systolic wall stress , the left ventricular ejection fraction , pulmonary capillary wedge pressure , and cardiac index
26666
Outcome_Physical
Plasma N-terminal-pro-B-type natriuretic peptide , tumor necrosis factor-alpha , and soluble Fas ligand levels
26667
Outcome_Physical
interleukin-6
26668
Outcome_Physical
Levosimendan-induced reduction in end-systolic wall stress
26669
Outcome_Physical
N-terminal-pro-B-type natriuretic peptide
26670
Outcome_Physical
tumor necrosis factor-alpha
26671
Outcome_Physical
soluble Fas
26672
Outcome_Physical
soluble Fas ligand
26673
Outcome_Mortality
Event-free survival
26674
Outcome_Physical
central hemodynamics
26675
Outcome_Physical
left ventricular performance