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Curso de Atualização em Medicina Cardiovascular 2019
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Levosimendan with other inotropes: should you combine them?
Session:
Posters 5 - Écran 5 - Insuficiência Cardíaca
Speaker:
Bruno M. Rocha
Congress:
CPC 2019
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.4 Acute Heart Failure– Treatment
Session Type:
Posters
FP Number:
---
Authors:
Bruno M. Rocha; Gonçalo Lopes Da Cunha; Rita Gomes; Inês Araújo; Cândida Fonseca
Abstract
<p><strong>Background: </strong>Levosimendan, an intravenous inotrope, may be used in selected patients with acute Heart Failure (HF). However, given its vasodilator properties, it is not suitable to treat those with hypotension [systolic blood pressure (SBP) <85mmHg] or cardiogenic shock, unless combined with other inotropes. Albeit common practice, such strategy is poorly investigated and may be not without risk. The main goals of this study were to determine the differences between patients receiving levosimendan vs levosimendan with another inotrope/vasopressor drug.</p> <p><strong>Methods: </strong>This work is based on a single-center HF care unit cohort assessing all patients who received levosimendan due to profile B (wet and warm) or C (wet and cold) acute HF. All definitions are as per the European Society of Cardiology recommendations on HF.</p> <p><strong>Results: </strong>From 2012 to 2018, a total of 88 patients received either combined inotropes (26,1%) or isolated levosimendan (73,9%). Mean age was 66,7 ± 12,0 years and mean left ventricular ejection fraction was 28,6 ± 11,6%. Other than diabetes (13,0% vs 53,8%, p=0,010), there were no significant differences in baseline demographics between groups. Patients who received combined inotropes were significantly more likely to present with cardiogenic shock (47,6% vs 9,8%, p=0,001) and to have lower mean arterial pressures at 1-hour (75 ± 10 vs 81 ± 10 mmHg, p=0,025) and 2-hours (74 ± 8 vs 81±13mmHg, p=0,033) after starting levosimendan. Minimum SBP during levosimendan infusion was significantly lower in this group (82 ± 9 vs 92 ± 12mmHg, p=0,002). Differences in levosimendan suspension (26,1% vs 7,9%, p=0,061) and supraventricular tachycardia (40,9% vs 21,0%, p=0,068) were not statistically significant. Also, no differences were noted in maximum levosimendan dose achieved, heart rate, urinary output or laboratory evaluation between groups. Finally, there was no difference in intra-hospital mortality (26,1% vs 13,8%, p=0,205).</p> <p><strong>Conclusions: </strong>In a dedicated HF unit, approximately 1 in every 4 patients who received levosimendan had it combined with another inotrope. There were no significant differences between groups on levosimendan suspension, adverse events or intra-hospital mortality, despite an expected dimer prognosis in patients receiving combined inotropes (noted by a significantly higher rate of cardiogenic shock). Levosimendan with another inotrope appears to be a useful and safe association in acute HF, yet this hypothesis warrants further investigation.</p>
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