Source: DGNews  |  Posted 4 years ago

By Crina Frincu-Mallos, PhD

WASHINGTON, DC -- September 19, 2007 -- Levosimendan treatment could potentially confer better therapeutic effects in right-ventricular function (RVF) compared with dobutamine, researchers reported here at the 11th Annual Scientific Meeting of the Heart Failure Society of America (HFSA).

Decreased RVF and acute heart failure (AHF) can occur simultaneously, resulting in hepatic congestion and increased levels of major hepatic enzymes. Treatment with levosimendan improves the circulating levels of enzymatic markers associated with hepatic congestion.

Cardiovascular Clinical Researcher Robert J. Padley, MD, Abbott Laboratories, Abbott Park, Illinois, United States, reported findings from Survival Of Patients With Acute Heart Failure In Need Of Intravenous Inotropic Support (SURVIVE), a large prospective, randomised, controlled trial, on behalf of his colleagues at Hospital Lariboisiere, Paris, France and Athens University Hospital Attikon, Athens, Greece.

The effect of levosimendan on RVF, compared to dobutamine, was indirectly assessed, noted Dr. Hadley, by examining changes in the levels of aspartate transaminase (AST), alanine transaminase (ALT), and alkaline phosphatase (AP) in subjects from the SURVIVE trial.

For all 664 patients treated with levosimendan as well as the 663 patients that received treatment with dobutamine, hepatic status was assessed at baseline and at 1, 3, and 5 days, using the AST, ALT, and AP enzymatic levels; gamma glutamyl transferase, bilirubin, albumin, prothrombin time, or cholesterol were not routinely collected in the SURVIVE trial.

For all subjects, changes in enzyme levels of AST, ALT, and AP were determined using the analysis of covariance model, with treatment and baseline serving as covariates.

Mean AST and ALT levels decreased over the 5 days, while AP levels decreased significantly on day 1 and returned to near baseline levels for dobutamine by day 5.

Furthermore, treatment with levosimendan resulted in a significant decrease in the AP levels on days 3 and 5, compared to dobutamine (P <.01).

When compared to dobutamine, levosimendan produced greater declines in the levels of all three hepatic enzymes over a 5-day period (P <.05).

"One of the 'easy' ways to get an indication of the impairment of the right ventricle is looking at liver enzymes. This study shows that treatment with levosimendan was associated with a greater reduction in those hepatic markers of right-ventricular dysfunction, compared with treatment with dobutamine, the standard-of-care," commented Jeffrey E. Salon, MD, Medical Director, Abbott Laboratories, Columbus, Ohio, United States.

[Presentation title: Levosimendan, Compared to Dobutamine, Reduces Enzymatic Markers Associated With Liver Congestion and Right Heart Failure: A SURVIVE Subanalysis. Abstract 235]