Inodilators in acute heart failure: what about the right ventricle?

Abstract Objectives This research examines the impact of levosimendan on right ventricular (RV) function in patients with cardiovascular conditions, aiming to evaluate enhancements in crucial echocardiographic indicators of RV systolic performance. Methods A total of 54 patients hospitalized for acute heart failure were enrolled in the study and divided into two groups: 25 patients received 12.5 mg of levosimendan over 24 hours, while the remaining 29 patients served as the control group. Echocardiographic parameters were measured at baseline and after treatment for both groups. Results In the levosimendan group, the post-treatment S' tissue velocity increased significantly from 9.48 ± 1.06 cm/s to 10.43 ± 1.28 cm/s (p=0.025), whereas the control group exhibited a change from 9.31 ± 0.93 cm/s to 9.53 ± 1.11 cm/s. The fractional area change (FAC) showed a notable improvement in the levosimendan group from 20 ± 3% to 27 ± 2% (p < 0.0001), compared to a minor change in the control group. Tricuspid annular plane systolic excursion (TAPSE) significantly increased in the levosimendan group from 13.8 ± 0.4 mm to 15.6 ± 0.36 mm (p < 0.0001), while the control group displayed minimal change. Systolic pulmonary artery pressure (SPAP) reduction was more significant in the levosimendan group (from 58.67 ± 7.28 mmHg to 47.22 ± 5.6 mmHg) compared to the control group (from 60.5 ± 9.34 mmHg to 55.85 ± 7.41 mmHg) (p=0.012). Additionally, RV strain improved considerably in the levosimendan group from -20 ± 3% to -23 ± 3% (p=0.03), while the control group changed from -19 ± 3% to -20 ± 3%. Conclusion Levosimendan markedly enhances right ventricular function, as demonstrated by significant increases in S' velocity, FAC, RV strain, and TAPSE, along with a notable reduction in SPAP. These results indicate that levosimendan is a promising therapeutic agent for improving RV function.