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Improvement of functional status and enhanced survival estimates after 330 levosimendan administrations
Session:
SESSÃO DE POSTERS 30 - INSUFICIÊNCIA CARDÍACA CRÓNICA: TRATAMENTO
Speaker:
Ana Filipa Mesquita Gerardo
Congress:
CPC 2025
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Cartazes
FP Number:
---
Authors:
Ana Filipa Mesquita Gerardo; Inês Miranda; Mariana Passos; Inês Fialho; Célia Henriques; Ana Oliveira Soares; Mara Sarmento; Rodrigo Brandão; David Roque; Carolina Mateus
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong>: Levosimendan, a calcium sensitizer with inotropic and vasodilatory effects, is utilized in advanced heart failure (adHF) for palliation or as a bridge to advanced therapies. With increasing real-world experience, evidence supporting its impact on adHF outcomes is growing.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Objectives</strong>: </span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">To evaluate changes in functional status, hospital admissions, and survival estimates in patients receiving intermittent intravenous (IV) levosimendan infusions in a dedicated heart failure (HF) unit.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: We conducted a single center study of consecutive adHF patients with reduced ejection fraction, integrated in the ambulatory intermittent levosimendan infusion program of our Institution. Patients were included if: 1) they were in New York HF Association (NYHA) class III-IV; 2) they had recurrent hospital admissions; 3) they were on maximum tolerated doses of guideline directed medical therapy. Exclusion criteria were acute infections, systolic arterial pressure less than 80 mmHg or severe hepatic dysfunction. They received levosimendan by continuous infusion (0,05-0,2 mcg/Kg/min) for 24 hours once a month or fortnightly, with no bolus dose. Vital signs, hemogram and biochemistry were evaluated before and up to 2 hours after the end of infusion. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong>: From january 2021 to august 2024 a total of 44 patients with 330 administrations were included. The median age was 67 (IQR 56-75) years, 84% were males (n=34). Ischemic HF was present in 64% (n=28) of patients, median ejection fraction was 23% (IQR 19-30) and 95% (n=42) were in NYHA class III. Six months after levosimendan infusion it was observed a significant reduction in hospital admissions (mean of 1.36 vs 0.53 before and after levosimendan program, respectively; p<0.001), a reduction in functional NYHA class (95% vs 22% of NYHA III, p<0.001). There was a trend towards lower NTproBNP after each cycle, although it was not significant (mean difference -2223, p=0.141) and creatinine showed a non-significant slight increase (1.58 to 1.72 g/dL; 9%). Survival estimated by the SEATTLE-HF model was higher after 6 months of levosimendan treatment, possibly reflecting disease stabilization - SEATTLE-HF at 5 years 46% vs 57% before and after levosimendan treatment, respectively; p=0.01 and SEATTLE-HF at 1 year 84% vs 88%; p=0.043.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong>: Intermittent levosimendan infusions are associated with improved functional status, reduced hospital admissions, and enhanced survival estimates in patients with adHF. A favorable trend in NT-proBNP reduction could further support its role in stabilizing disease progression.</span></span></p>
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