Comparative effects of levosimendan and dobutamine infusion on p wave dispersion in patients with acute decompensated heart failure

We aimed to evaluate the comparative effects of levosimendan and dobutamine on P-wave dispersion (PWD) in the patients with acute decompensated heart failure (ADHF). Materials and methods: The study population consisted of 40 patients (mean age = 68 years, 23 men, NYHA class III-IV) presented with ADHF. Patients were randomized to intravenous levosimendan (n = 20) or dobutamine (n = 20) groups. The P-wave duration measurements were calculated in 12-lead surface ECG simultaneously and recorded before and after treatment. Manual measurements of P-wave duration were performed with digital calipers on a high resolution computer screen by two cardiologists not aware of the patients' clinical data. Results: There were no significant changes in P max in the dobutamine group whereas a significant decrease was observed in the levosimendan group after the infusion. The levosimendan infusion significantly reduced PWD (from 40 msec to 30 msec, P < 0.001) but the dobutamine infusion has no effect on PWD. In hospital new onset atrial fibrillation (AF) frequency was similar among two groups. Conclusion: Levosimendan infusion significantly reduces PWD compared to dobutamine infusion in our study population. This finding may be related to hemodynamic improvements provided by levosimendan.

Comparative effects of levosimendan and dobutamine infusion on p wave dispersion in patients with acute decompensated heart failure

We aimed to evaluate the comparative effects of levosimendan and dobutamine on P-wave dispersion (PWD) in the patients with acute decompensated heart failure (ADHF). Materials and methods: The study population consisted of 40 patients (mean age = 68 years, 23 men, NYHA class III-IV) presented with ADHF. Patients were randomized to intravenous levosimendan (n = 20) or dobutamine (n = 20) groups. The P-wave duration measurements were calculated in 12-lead surface ECG simultaneously and recorded before and after treatment. Manual measurements of P-wave duration were performed with digital calipers on a high resolution computer screen by two cardiologists not aware of the patients' clinical data. Results: There were no significant changes in P max in the dobutamine group whereas a significant decrease was observed in the levosimendan group after the infusion. The levosimendan infusion significantly reduced PWD (from 40 msec to 30 msec, P < 0.001) but the dobutamine infusion has no effect on PWD. In hospital new onset atrial fibrillation (AF) frequency was similar among two groups. Conclusion: Levosimendan infusion significantly reduces PWD compared to dobutamine infusion in our study population. This finding may be related to hemodynamic improvements provided by levosimendan.

___

  • Felker GM, O'Connor CM. Inotropic therapy for heart failure: an evidence-based approach. Am Heart J 2001; 142: 393-401. 2. Cuffe MS, Califf RM, Adams KF Jr, Benza R, Bourge R, Colucci WS et al.. Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) Investigators. Short-term intravenous milrinone for acute exacerbation of chronic heart failure: a randomized controlled trial. JAMA 2002; 287: 1541-7.
  • Bayram M, De Luca L, Massie MB, Gheorghiade M.
  • Reassessment of dobutamine, dopamine, and milrinone in the
  • management of acute heart failure syndromes. Am J Cardiol
  • ; 96: 47G-58G. 4.
  • Haikala H, Kaivola J, Nissinen E, Wall P, Levijoki J, Lindén IB.
  • Cardiac troponin C as a target protein for a novel calcium
  • Follath F, Cleland JG, Just H, Papp JG, Scholz H, Peuhkurinen K et al. Steering Committee and Investigators of the Levosimendan Infusion versus Dobutamine (LIDO) Study. 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.
  • Packer M, Carver JR, Rodeheffer RJ, Ivanhoe RJ, DiBianco R, Zeldis SM et al. Effect of oral milrinone on mortality in severe chronic heart failure. The PROMISE Study Research Group. N Engl J Med 1991; 325: 1468–75.
  • Nony P, Boissel JP, Lievre M, Leizorovicz A, Haugh MC, Fareh S et al. Evaluation of the effect of phosphodiesterase inhibitors on mortality in chronic heart failure patients. A metaanalysis. Eur J Clin Pharmacol 1994; 46: 191–6.
  • Singh BN, Lilleberg J, Sandell E-P, Ylönen V, Lehtonen L, Toivonen L. Effects of levosimendan on cardiac arrhythmias: electrophysiologic and ambulatory electrocardiographic findings in Phase II and III clinical studies in cardiac failure. Am J Cardiol 1999; 24 Suppl I: 16(I)–20(I).
  • Lilleberg J, Ylönen V, Lehtonen L, Toivonen L. The calcium sensitizer levosimendan and cardiac arrhythmias: an analysis of the safety database of heart failure treatment studies. Scand Cardiovasc J 2004; 38: 80-4.
  • Dilaveris P, Batchvarov V, Gialafos J, Malik M. Comparison of different methods for manual P-wave duration measurement in 12-lead electrocardiograms. Pacing Clin Electrophysiol 1999; 22: 1532-8.
  • Edes I, Kiss E, Kitada Y, Powers FM, Papp JG, Kranias EG et al. Effects of Levosimendan, a cardiotonic agent targeted to troponin C, on cardiac function and on phosphorylation and Ca2+ sensitivity of cardiac myofibrils and sarcoplasmic reticulum in guinea pig heart. Circ Res 1995; 77: 107-13.
  • Sorsa T, Pollesello P, Solaro RJ. The contractile apparatus as a target for drugs against heart failure: interaction of levosimendan, a calcium sensitiser, with cardiac troponin C. Mol Cell Biochem 2004; 266: 87-107.
  • Haikala H. Non-clinical studies on arrythmogenity of levosimendan. Research Report: Orion Pharma; 2003 November 11 Report No: NDO090017.
  • Moiseyev VS, Põder P, Andrejevs N, Ruda MY, Golikov AP, Lazebnik LB et al. RUSSLAN Study Investigators. Safety and efficacy of a novel calcium sensitizer, levosimendan, in patients with left ventricular failure due to an acute myocardial infarction. A randomized, placebo-controlled, double-blind study (RUSSLAN). Eur Heart J 2002; 23: 1422-32.
  • Binkley PF, Nunziata E, Hatton PS, Leier CV. The positive inotropic agent levosimendan mediates increased cardiac output without progression of sympathovagal imbalance in patients with heart failure. Circulation 2000; 102 (Suppl II): 720–1.
  • Toivonen L, Viitasalo M, Sundberg S, Akkila J, Lehtonen L. Electrophysiologic effects of a calcium sensitizer inotrope levosimendan administered intravenously in patients with normal cardiac function. J Cardiovasc Pharmacol 2000; 35: 664-9.
  • Packer M. REVIVE II: Multicenter placebo-controlled trial of levosimendan on clinical status in acutely decompensated heart failure. Program and abstracts from the American Heart Association Scientific Sessions 2005; November 13-16, 2005; Dallas, Texas. Late Breaking Clinical Trials II.
  • Mebazaa A, Nieminen MS, Packer M, Cohen-Solal A, Kleber FX, Pocock SJ et al. SURVIVE Investigators. Levosimendan vs dobutamine for patients with acute decompensated heart failure: the SURVIVE Randomized Trial. JAMA 2007; 297: 1883-91.
  • Dilaveris PE, Gialafos JE. P-wave dispersion: A novel predictor of paroxysmal atrial fibrillation. Ann Noninvasive Electrocardiol 2001; 6: 159–65.
  • Parissis JT, Panou F, Farmakis D, Adamopoulos S, Filippatos G, Paraskevaidis I et al. Effects of levosimendan on markers of left ventricular diastolic function and neurohormonal activation in patients with advanced heart failure. Am J Cardiol 2005; 96: 423-6.
  • Janssen PM, Datz N, Zeitz O, Hasenfuss G. Levosimendan improves diastolic and systolic function in failing human myocardium. Eur J Pharmacol 2000; 404: 191-9. Tachibana H, Cheng HJ, Ukai T, Igawa A, Zhang ZS, Little WC et al. Levosimendan improves LV systolic and diastolic performance at rest and during exercise after heart failure. Am J Physiol Heart Circ Physiol 2005; 288: H914-22.
Turkish Journal of Medical Sciences-Cover
  • ISSN: 1300-0144
  • Yayın Aralığı: Yılda 6 Sayı
  • Yayıncı: TÜBİTAK
Sayıdaki Diğer Makaleler

Penile Mondor's disease can be effectively treated with the use of an acetyl salicylic acid and pentoxifylline combination

Ahmet Namık KİPER, Mürsel DAVARCI, Ahmet GÖKÇE, Eşref Oğuz GÜVEN, Fatih Rüştü YALÇINKAYA, Mevlana Derya BALBAY

Comparative effects of levosimendan and dobutamine infusion on p wave dispersion in patients with acute decompensated heart failure

Murat ÇELİK, Barış BUĞAN, Turgay ÇELİK, Halil YAMAN, Atila İYİSOY

Prevalence of anaemia in women of reproductive age in Meghalaya: A logistic regression analysis

Madhuchhanda GOSWAMI, Sankar GOSWAMI, Sanku DEY

Penile Mondor's disease can be effectively treated with the use of an acetyl salicylic acid and pentoxifylline combination

Mürsel DAVARCI, Eşref Oğuz GÜVEN, Ahmet GÖKÇE, Fatih Rüştü YALÇINKAYA, Ahmet Namık KİPER, Mevlana Derya BALBAY

Two siblings with Netherton syndrome

Selma EMRE, Ahmet METİN, Aykut ONURSEVER, D. Deniz DEMİRSEREN, Burçin KAFTAN, Ahu YORULMAZ

Karagenin ile oluşturulmuş pençe ödemi modelinde 3-benzoil-1-metil-4-fenil-4- piperidinol-hidroklorür (C1), indometazin, nimesulid ve rofekoksib’in siklooksijenaz enzim aktiviteleri üzerine olan etkileri

Halis SÜLEYMAN, Hülya AKSOY, Berna DEMİRCAN, Yaşar Nuri ŞAHİN, Halise İnci GÜL

Does central corneal thickness correlate with haemoglobin A1c level and disease severity in diabetes type II?

Mehmet Özgür ZENGİN, Zeynep ÖZBEK, Gül ARIKAN, İsmet DURAK, Ali Osman SAATCİ

Dissection of mesoappendix in laparoscopic appendectomy: a comparison of monopolar cautery and bipolar vessel sealing system

Emrah ŞENEL, Hüseyin Tuğrul TİRYAKİ, Halil Faruk ATAYURT, Fatih AKBIYIK

Prediction of prostate cancer using decision tree algorithm

Kemal Hakan GÜLKESEN, Sebahat ÖZDEM, Osman SAKA, İsmail Türker KÖKSAL

Feminizing genitoplasty: an evaluation of 41 patients in 8 years

Emrah ŞENEL, Ervin MAMBET, Tuğrul TİRYAKİ, Ziya LİVANELİOĞLU, Fatih AKBIYIK, Halil ATAYURT