The quantitative haemodynamic effect of levosimendan, dobutamine, and milrinone in heart failure patients: a meta-analysis
Abstract
Introduction: Inotropic therapy is a cornerstone of medical treatment for patients with low-output heart failure (HF). We aimed to investigate the quantitative effect of specific inotropic drugs on invasive haemodynamics.
Methods: This meta-analysis assessed the haemodynamic effects of dobutamine, levosimendan, and milrinone in patients with low-output HF. Only studies using invasive haemodynamic assessment were included. The primary outcome was the quantitative change in variables such as cardiac index, pulmonary artery wedge pressure, mean pulmonary artery pressure, mean arterial pressure (MAP), pulmonary and systemic vascular resistance (before and after administration of each drug. Quality was assessed using the National Institutes of Health Quality Assessment Tool (NIH-QAT). A sensitivity analysis compared the effect on acute versus chronic HF populations.
Results: Twenty-six studies (n = 1888 patients) were included in the analyses. Based on the NIH-QAT checklist, 11 studies were at low risk of bias, 14 at moderate risk, and 1 at high risk. Meta-analysis showed that all the study drugs improved the haemodynamic variables assessed, without significant differences amongst them, except for MAP (P = .0486). Dobutamine and levosimendan caused a non-significant increase in MAP, while milrinone showed a trend towards a reduction in MAP [-3.46 (-7.27 to +0.35)]. The heterogeneity across studies was high. In the sensitivity analysis, dobutamine improved CI more than…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,888 participants or records.
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