Effect of β-blockade on the haemodynamic responses of levosimendan and dobutamine in the treatment of low-output heart failure

The novel calcium sensitiser, levosimendan (LS), and the β-adrenoceptor agonist dobutamine (DO), both improve cardiac haemodynamics in patients withsevere low-output heart failure (HF). However, co-administration of β-blockers may influence the action of these inotropic agents.

In a multicentre, randomised, double-blind trial in patients with severe low output HF (n = 203), the haemodynamic effects of LS and DO infusions over 24 hours were compared. The influence of concomitant β-blocker therapy (37% in the LS and 39% in the DO groups) were analysed separately. Patients were given either LS (loading dose of 24 μg/kg over 10 min followed by a continuous infusion of 0.1 μg/kg/min), or DO (continuous infusion of 5 μg/kg/min). The infusion rates were doubled if the cardiac index did not increase by ≥ 30% after 2 hours of treatment.

The use of β-blockers had significant effects on the increase in cardiac output and the decrease in pulmonary wedge pressure (P = 0.01 and P = 0.03, respectively) (Fig. 1). β-blockade attenuated the effect of DO but did not reduce the effects of LS. There was even a slight trend for improved haemodynamic benefits of LS in patients under β-blockade. These findings suggest that LS may be successfully combined with β-blockers to treat patients with low-output heart failure.

Figure 1

Mean changes in cardiac output (CO) and pulmonary capillary wedge pressure (PCWP) in patients given LS (β- n = 69 and β+ n = 33) and DO (β- n = 67 and β+ n = 28).