Comparative safety and efficacy of levosimendan versus dobutamine in acute heart failure: a systematic review, meta-analysis, and meta-regression.

Levosimendan was associated with a higher incidence of hypotension than dobutamine, although it failed to reach statistical significance (SMD: − 0.33; CI [−0.58, − 0.08]; P = 0.010) with an insignificant amount of heterogeneity (I 2 = 1%; P = 0.31) (Supplemental Digital Content Figure 18, available at: http://links.lww.com/MS9/B74 ).

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Multicenter trials of mortality within 30 days demonstrated a neutral effect (RR 0.82, 95% CI 0.63–1.06; P = 0.13; I 2 = 0%), whereas single-center studies suggested a nonsignificant trend toward benefit (RR 0.63, 95% CI 0.20–1.95; P = 0.42; I 2 = 39%) (Supplemental Digital Content Table 5A, available at: http://links.lww.com/MS9/B74 ).

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A favorable trend toward levosimendan was observed in short-term (30-day) mortality; RRs ranged from 0.65 to 0.85, and our studies showed statistically significant results ( P < 0.05), suggesting a possible survival benefit during the acute phase.

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Although the effect did not reach statistical significance, the directionality favored a small chronotropic effect.

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