Levosimendan in acute decompensated heart failure: Systematic review and meta-analysis

Objectives To assess the risks and benefits of levosimendan in acute decompensated heart failure compared to dobutamine or placebo. Methods Pubmed, the Cochrane Central Register of Controlled Trials (CENTRAL), the European Heart Journal, and the Journal of the American College of Cardiology and Circulation were searched for randomized clinical trials of a 24 h IV infusion of levosimendan compared to dobutamine or a placebo in patients ≥18 years old admitted with a diagnosis of acute decompensated heart failure of any etiology with a NYHA class III and IV heart failure, a left ventricular ejection fraction 15 mmHg or cardiac index Results Eleven clinical trials (2747 patients) met the inclusion criteria for this review. Levosimendan was associated with a significant increase in NYHA class OR 3.06 (95% CI 1.23–7.59; p = 0.02), and a tendency to improve fatigue OR 1.80 1.53 (IC95% 0.99–2.39, p = 0.06) and clinical improvement composite OR 1.20 (IC95% 0.99–1.46; p = 0.06), as compared to dobutamine or a placebo. Conclusions Levosimendan in acute decompensated heart failure improves NYHA functional class, LVEF and BNP levels when compared to dobutamine or a placebo, with an increase in side effects.