Effects of levosimendan versus dobutamine on pressure load-induced right ventricular failure

Crit Care Med. 2006 Nov;34(11):2814-9. doi: 10.1097/01.CCM.0000242157.19347.50.


Objective: A transient increase in pulmonary arterial (PA) pressure can persistently depress right ventricular (RV) contractility. We investigated the effects of dobutamine and levosimendan on RV-PA coupling in this model of RV failure.

Design: Prospective, controlled, randomized animal study.

Setting: University research laboratory.

Subjects: Fifteen anesthetized dogs.

Interventions: Transient (90-min) PA constriction to induce persistent RV failure. Random assignment to dobutamine 5 and 10 microg/kg/min or levosimendan 12 microg/kg for 10 mins followed by 0.1 and 0.2 microg/kg/min.

Measurements and main results: We measured PA distal resistance and proximal elastance by pressure-flow relationships and vascular impedance. We measured RV contractility by the end-systolic pressure-volume relationship (Ees), PA effective elastance by the end-diastolic to end-systolic relationship (Ea), and RV-PA coupling efficiency by the Ees/Ea ratio. PA constriction persistently increased PA resistance and elastance, increased Ea from 0.95 +/- 0.07 to 3.01 +/- 0.28 mm Hg/mL, decreased Ees from 1.17 +/- 0.09 to 0.58 +/- 0.07 mm Hg/mL, and decreased Ees/Ea from 1.26 +/- 0.09 to 0.22 +/- 0.03 (p < .05). Dobutamine did not affect pulmonary hemodynamics, markedly increased RV contractility, and improved RV-PA coupling. Levosimendan decreased PA resistance and elastance, increased RV contractility, and restored RV-PA coupling. Compared with dobutamine, levosimendan decreased RV afterload and therefore better restored RV-PA coupling at similar inotropic state.

Conclusions: A transient increase in PA pressure persistently worsens PA hemodynamics, RV contractility, RV-PA coupling, and cardiac output. Levosimendan restores RV-PA coupling better than dobutamine because of similar inotropic effects and additional pulmonary vasodilatory effects.

Publication types

  • Comparative Study
  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Cardiotonic Agents / therapeutic use*
  • Dobutamine / therapeutic use*
  • Dogs
  • Heart Failure / drug therapy*
  • Heart Failure / etiology
  • Hydrazones / therapeutic use*
  • Hypertension, Pulmonary / complications*
  • Prospective Studies
  • Pulmonary Artery / drug effects
  • Pulmonary Circulation / drug effects
  • Pyridazines / therapeutic use*
  • Random Allocation
  • Simendan
  • Ventricular Dysfunction, Right / drug therapy*
  • Ventricular Dysfunction, Right / etiology


  • Cardiotonic Agents
  • Hydrazones
  • Pyridazines
  • Simendan
  • Dobutamine