{"id":"172e763fe967","type":"article","url":"https://hartvaat.nl/2026/05/05/inotropica-bij-low-output-hartfalen-vergelijkbare-hemodynamische-effecten-in-met/","title":"Inotropica bij low-output hartfalen: vergelijkbare hemodynamische effecten in meta-analyse","title_en":"The Quantitative Haemodynamic Effect of Levosimendan, Dobutamine and Milrinone in Heart Failure Patients: a Meta-Analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["acuut-hartfalen","bisoprolol","hfmref","hfpef","hfref","ijzertekort"],"journal":"ESC heart failure","doi":"10.1093/eschf/xvag120","source_url":"https://doi.org/10.1093/eschf/xvag120","authors":["Vincenzo Nuzzi","Cristina Madaudo","Paolo Manca","Antonio Cannata","Giuseppe Raffa","Massimiliano Mulè","Stefano Cannata","Eluisa La Franca","Calogera Pisano","Manlio Cipriani","Roberto Lorusso"],"significance":6,"published":"2026-05-24","source_date":"2026-05-05","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/invasieve-hemodynamiek-rechts-hartkatheterisatie/","https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"Meta-analysis of 26 studies (1,888 patients) comparing the invasively measured haemodynamic effects of dobutamine, levosimendan and milrinone in low-output heart failure. All three agents improved cardiac index, PCWP, mean pulmonary and arterial pressures, and pulmonary/systemic vascular resistance, without consistent superiority of any one drug. The only significant difference concerned mean arterial pressure (p=0.05): milrinone trended toward a reduction, while dobutamine and levosimendan slightly raised it. In a sensitivity analysis, dobutamine improved cardiac index more than levosimendan in chronic HF. Findings support current practice of selecting inotropes based on individual patient characteristics.","created":"2026-07-03T10:32:57Z","updated":"2026-07-03T18:39:33Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse van 26 studies (1.888 patiënten) waarin de invasief gemeten hemodynamische effecten van dobutamine, levosimendan en milrinone bij low-output hartfalen werden vergeleken. Alle drie middelen verbeterden de cardiale index, PCWP, gemiddelde pulmonale en arteriële druk, en pulmonale/systemische vaatweerstand, zonder consistente superioriteit van één agent. Het enige significante verschil betrof de gemiddelde arteriedruk (p=0,05): milrinone vertoonde een trend naar daling, dobutamine en levosimendan een lichte stijging. In de sensitiviteitsanalyse verbeterde dobutamine de cardiale index meer dan levosimendan bij chronische HF. De bevindingen ondersteunen de huidige praktijk waarin de keuze van het inotropicum wordt afgestemd op individuele patiëntkenmerken.","abstract_original":"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 levosimendan in patients with chronic HF. CONCLUSION: The use of inotropes improves haemodynamic status in patients with low-output HF, with no consistent superiority of one agent over the others. These findings support the current clinical practice of agent selection based on individual patient characteristics. Head-to-head trials in well-phenotyped HF populations are warranted to guide personalized inotrope use."}