To synthesize the available evidence regarding differences in the long-term safety and efficacy of intermittent, repeated, or continuous palliative inotropic therapy among patients with advanced heart failure (HF). We systematically searched the PubMed, Embase, and Cochrane Library electronic databases, with a cutoff date of November 23, 2023, for studies reporting outcomes in adult patients with advanced HF treated with intermittent, repeated, or continuous levosimendan, milrinone, or dobutamine. Forty-one studies (18 randomized controlled trials and 23 cohort studies) comprising 5137 patients met the inclusion criteria. The results of the network meta-analysis of randomized controlled trials showed that levosimendan had significant advantages over milrinone or dobutamine in reducing mortality and improving LVEF. A single-arm meta-analysis also indicated that levosimendan had the lowest mortality and significantly improved BNP and LVEF. Regarding safety, hypotension events were observed more frequently in the levosimendan group and milrinone groups. However, the current evidence is limited by the heterogeneity and relatively small sample size of the studies.

中文翻译：

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晚期心力衰竭患者间歇、重复或连续使用左西孟旦、米力农或多巴酚丁胺的有效性和安全性比较：网络和单臂荟萃分析。

旨在综合有关晚期心力衰竭 (HF) 患者间断、重复或连续姑息性正性肌力治疗的长期安全性和有效性差异的现有证据。我们系统地检索了 PubMed、Embase 和 Cochrane 图书馆电子数据库（截止日期为 2023 年 11 月 23 日），查找报告晚期心力衰竭成人患者接受间歇、重复或连续左西孟旦、米力农或多巴酚丁胺治疗结果的研究。包含 5137 名患者的 41 项研究（18 项随机对照试验和 23 项队列研究）符合纳入标准。随机对照试验的网络荟萃分析结果表明，左西孟旦在降低死亡率和改善LVEF方面比米力农或多巴酚丁胺具有显着优势。单臂荟萃分析还表明，左西孟旦的死亡率最低，并且显着改善 BNP 和 LVEF。关于安全性，低血压事件在左西孟旦组和米力农组中更常见。然而，目前的证据受到研究的异质性和相对较小的样本量的限制。