Heart failure & cardiomyopathiesMeta-analysis
The quantitative haemodynamic effect of levosimendan, dobutamine, and milrinone in heart failure patients: a meta-analysis
- meta-analysis
- Only studies using invasive haemodynamic assessment were included
Authors' 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.
Study context
- Population
- Patients with low-output heart failure (HF)
- Participants
- 1,888 Twenty-six studies
- Comparison
- haemodynamic effects of dobutamine, levosimendan, and milrinone, before and after administration of each drug
- Outcome
- Quantitative change in cardiac index, pulmonary artery wedge pressure, mean pulmonary artery pressure, mean arterial pressure (MAP), pulmonary and systemic vascular resistance
- Follow-up
- Before and after administration of each drug
Pooled result
As reported in the abstract
milrinone
−3.46
change in mean arterial pressure (MAP) · interval −7.27 to +0.35
- All the study drugs improved the haemodynamic variables assessed, without significant differences amongst them, except for MAP
- P = 0.0486
Further pooled results
Risk of bias (National Institutes of Health Quality Assessment Tool (NIH-QAT))
- Studies at low risk of bias
- 11
- Studies at moderate risk
- 14
- Studies at high risk
- 1
CI in chronic HF (sensitivity analysis)
- Dobutamine improved CI more than levosimendan in patients with chronic HF
Original publication
The quantitative haemodynamic effect of levosimendan, dobutamine, and milrinone in heart failure patients: a meta-analysis. ESC Heart Fail. Published 24 April 2026. doi:10.1093/eschf/xvag120
Summarised from the published abstract; every number is checked against it