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Intermittent Levosimendan Therapy in Advanced Heart Failure Patients Awaiting Heart Transplantation: A Single-Center Experience
Session:
SESSÃO DE POSTERS 30 - INSUFICIÊNCIA CARDÍACA CRÓNICA: TRATAMENTO
Speaker:
Ricardo Carvalheiro
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:
Ricardo Carvalheiro; Ana Raquel Santos; Rita Teixeira; António Valentim Gonçalves; Rita Moreira; Tiago Pereira da Silva; Valdemar Gomes; Pedro Coelho; Rui Soares
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> Advanced heart failure patients often require bridging strategies to heart transplantation (HTx) due to their clinical instability. Levosimendan, a calcium sensitizer with inotropic and vasodilatory properties, has emerged as a potential option to optimize hemodynamic status while reducing the need for frequent hospitalizations. We aimed to evaluate the impact of intermittent levosimendan therapy in a cohort of patients with advanced heart failure awaiting HTx.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> This retrospective study included patients categorized as INTERMACS 3, receiving intermittent levosimendan infusions at a single tertiary center. Baseline and pre-transplant hemodynamic and biomarker parameters were analyzed. Clinical stability and short-term survival outcomes were assessed.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> The cohort consisted of 21 pts (median age 42 [IQR : 32-67] years, 67% male). The main etiology for heart failure was ischemic heart disease (7pts, 33%). Pt characteristics are displayed in table 1. Levosimendan was administered in 6-hour infusions every two weeks, for a median of 111 (IQR: 54-257) days until HTx. During treatment, median NTproBNP levels showed a decrease from 4269.0 to 3112.5 (p = 0.286) and troponin levels slightly declined from 33.40 to 29.85 (p = 0.758), but the changes were not statistically significant. Mean glomerular filtration rate (GFR) also remained stable during treatment (63.4 vs 63.8, p = 0.887). Despite 67% of pts having history of hospital admission for heart-failure in the 6 months prior to levosimendan initiation, only 3 pts (14%) required emergency admission during treatment. All pts successfully underwent HTx with no evidence of inotrope-dependent vasoplegia related to prior levosimendan administration. 2 pts died during the first 30 days after transplantation due to severe graft dysfunction.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions:</strong> Intermittent levosimendan therapy demonstrated utility as a bridging strategy for heart transplantation in advanced heart failure patients, providing hemodynamic stability and reducing emergency hospitalizations. Our findings support the use of intermittent levosimendan as a safe and effective adjunctive therapy in carefully selected INTERMACS 3 patients, optimizing pre-transplant stability without adversely affecting transplant outcomes. </span></span></p>
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