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A real world experience of 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:
10.4 Chronic Heart Failure – Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Filipa Gerardo; Inês Miranda; Carolina Mateus; Mariana Passos; Inês Fialho; Célia Henriques; Ana Oliveira Soares; Mara Sarmento; Rodrigo Brandão; David Roque
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Calibri",sans-serif">Introduction: Levosimendan is a positive inotrope used in advanced heart failure (adHF) as a bridge to heart transplant, to decision, to recovery or as a palliative therapy. As the experience with this calcium sensitizer increases, real world data is becoming more robust about the benefits on adHF.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Calibri",sans-serif">Objectives: To describe the experience of intermittent intravenous (IV) administration of 24-hour Levosimendan infusions in adHF patients. </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Calibri",sans-serif">Methods: We conducted a single center study of consecutive adHF patients with reduced ejection fraction, integrated in the ambulatory intermittent levosimendan infusion program of our HF unit . 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></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Calibri",sans-serif">Results: From january 2021 to august 2024, 44 patients underwent 330 levosimendan infusions. Median age was 67 years (IQR 56-75), and 84% (n=34) were male. Ischemic HF was observed in 64% (n=28), median ejection fraction was 23% (IQR 19-30), and 95% (n=42) were in NYHA class III. Most patients were chronically medicated with guideline directed medical therapy: beta-blockers (89%), ACE inhibitors/ARNI (100%), MRAs (89%), and SGLT2 inhibitors (86%). Palliation was the treatment goal in 41% (n=20) whereas 32% (n=14) were candidates for heart transplant or left ventricle assistant device (LVAD). The initial infusion frequency was monthly for 84% (n=37) of patients, with 18% (n=8) requiring an increase to fortnightly dosing due to clinical deterioration. The mean treatment duration was 7 ± 5 months. NT-proBNP decreased by 30% (7660 ng/dL to 5436 ng/dL) over 6 months. Notably, 60% of patients discontinued levosimendan due to improved functional status and HF stabilization. Four patients underwent heart transplantation, and one received LVAD. By December 2024, there were 7 deaths (16%): 4 from advanced HF, 2 of unknown causes, and 1 from meningitis.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Conclusion: Intermittent 24-hour IV levosimendan infusions were safe and effective in stabilizing advanced heart failure, improving functional status, and reducing NT-proBNP levels. These findings support levosimendan as a valuable option in advanced heart failure management.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"> </p>
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