Clinical Research in Cardiology

, Volume 105, Issue 12, pp 971–980 | Cite as

Similar hemodynamic decongestion with vasodilators and inotropes: systematic review, meta-analysis, and meta-regression of 35 studies on acute heart failure

  • Shiro Ishihara
  • Etienne Gayat
  • Naoki Sato
  • Mattia Arrigo
  • Said Laribi
  • Matthieu Legrand
  • Rui Placido
  • Philippe Manivet
  • Alain Cohen-Solal
  • William T. Abraham
  • Mariell Jessup
  • Alexandre Mebazaa
Original Paper



Acute heart failure (AHF) with reduced left-ventricular ejection fraction (LVEF) is often a biventricular congested state. The comparative effect of vasodilators and inotropes on the right- and/or left-sided congestion is unknown.

Methods and results

A systematic review, meta-analysis, and meta-regression of AHF studies using pulmonary artery catheter were performed using PubMed, Embase, and Cochrane library. Data from 35 studies, including 3016 patients, were studied. Included patients had a weighted mean age of 60 years, left-ventricular ejection fraction (LVEF) of 24 %, and plasma B-type natriuretic peptide (BNP) of 892 pg/ml. Both the left- and right-ventricular filling pressures were elevated: weighted mean pulmonary artery wedge pressure (PAWP) was 25 mmHg (range 17–31 mmHg) and right atrial pressure (RAP) 12 mmHg (range 7–18 mmHg). Vasodilators and inotropes had similar beneficial effects on PAWP [−6.3 mmHg (95 % CI −7.4 to −5.2 mmHg) and −5.8 mmHg (95 % CI −7.6 to −4.0 mmHg), respectively] and RAP [−2.9 mmHg (95 % CI −3.8 to −2.1 mmHg) and −2.8 mmHg (95 % CI −3.8 to −1.7 mmHg), respectively]. Among inotropes, inodilators, such as levosimendan, have greater beneficial effect on the left-ventricular filling pressure than dobutamine. Drug-induced improvement of PAWP tightly paralleled that of RAP with all studied drugs (r 2 = 0.90, p < 0.001). Vasodilators and inotropes had no short-term effect of renal function.


The left- and right-sided filling pressures are similarly improved by vasodilators or inotropes, in AHF with reduced LVEF.


Acute heart failure Inotropes Vasodilators Hemodynamics Congestion Decongestion Meta-analysis Meta-regression 



AM received speaker’s honoraria from The Medicines Company, Novartis, Orion, Roche, Servier, Vifor Pharma; AM received fee as member of advisory board and/or Steering Committee from Cardiorentis, The Medicine Company, Adrenomed, MyCartis and Critical Diagnostics. EG received fee as member of advisory board from Magnisense and Adrenomed.

Compliance with ethical standards

Conflict of interest

No conflicts of interest for the other coauthors.

Supplementary material

392_2016_1009_MOESM1_ESM.pdf (434 kb)
Supplementary material 1 Suppl Fig. 1–4: Comparison of changes in systemic hemodynamics between inotropes and vasodilators. Suppl Fig. 5: Comparison of safety parameters between inotropes and vasodilators. Suppl Fig. 6: Change in creatinine levels after drug administration. Only trials were studied, vasodilators are in blue, inotropes in red, and placebo arms in green (PDF 434 kb)
392_2016_1009_MOESM2_ESM.docx (47 kb)
Supplementary material 2 (DOCX 46 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Shiro Ishihara
    • 1
    • 2
  • Etienne Gayat
    • 2
    • 3
    • 4
  • Naoki Sato
    • 1
  • Mattia Arrigo
    • 2
    • 4
    • 5
  • Said Laribi
    • 2
    • 3
    • 6
  • Matthieu Legrand
    • 2
    • 3
    • 4
  • Rui Placido
    • 2
    • 7
  • Philippe Manivet
    • 2
    • 8
    • 9
  • Alain Cohen-Solal
    • 2
    • 3
    • 10
  • William T. Abraham
    • 11
  • Mariell Jessup
    • 12
  • Alexandre Mebazaa
    • 2
    • 3
    • 4
  1. 1.Cardiology DepartmentSteel Memorial Yawata HospitalKitakyushuJapan
  2. 2.Inserm UMR-S 942ParisFrance
  3. 3.University Paris Diderot, Sorbonne Paris CitéParisFrance
  4. 4.Department of Anesthesia and Critical MedicineHôpitaux Universitaires Saint Louis-Lariboisière, AP-HPParisFrance
  5. 5.Division of Cardiology, University Heart CenterUniversity Hospital ZurichZurichSwitzerland
  6. 6.Department of Emergency MedicineHôpitaux Universitaires Saint Louis-Lariboisière, AP-HPParisFrance
  7. 7.Hospital Santa Maria, Serv Cardiologia ILisbon Academic Medical Centre, CCULLisbonPortugal
  8. 8.Department of BiochemistryLariboisière HospitalParis Cedex 10France
  9. 9.France Center for Biological ResourcesLariboisière HospitalParisFrance
  10. 10.Department of CardiologyHôpitaux Universitaires Saint Louis-LariboisièreParisFrance
  11. 11.Division of Cardiovascular MedicineThe Ohio State UniversityColumbusUSA
  12. 12.The Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA

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