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Levosimendan therapy in patients with acutely decompensated chronic heart failure – outcomes and mortality predictors
Session:
Painel 1 - Insuficiencia cardiaca 5
Speaker:
Alexandra Briosa
Congress:
CPC 2020
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Posters
FP Number:
---
Authors:
Alexandra Briosa; Sofia Alegria; Ana Catarina Gomes; Ana I. Marques; Daniel Sebaiti; Ana Rita F. Pereira; João Grade Santos; Otilia Ferreira Simões ; Ana Almeida; Rita Miranda; Helder Pereira
Abstract
<p><strong><em>Introduction: </em></strong>Levosimendan is a novel agent for the treatment of acutely decompensated chronic heart failure (ADCHF). Besides patient’s (pts) hemodynamic and symptomatic improvement, levosimendan also showed a survival advantage. </p> <p><strong><em>Aim: </em></strong>To characterize the population of pts with ADCHF who were submitted do levosimendan treatment in what concerns baseline characteristics and long-term outcomes, as well as to determine mortality predictors. </p> <p><strong><em>Methods: </em></strong>Single center retrospective study that analyzed pts with ADCHF submitted to levosimendan therapy inf the last 10 years (2008-2018). Clinical and imaging data were collected, as well as long term outcomes (hospital admission and mortality). Uni and multivariate analysis were used to determine mortality predictors. </p> <p><strong><em>Results:</em></strong> We analyze a total of 106 hospitalizations in 75 pts, 81% males with a mean age of 66±45years old. </p> <p>75% of pts were in NYHA class 4 and the mean left ventricle ejection fraction (LVEF) was 22.6±6,9%.</p> <p>The average number of previous HF admissions was 1,5±1,2, with a mean hospitalization time of 25±21 days. </p> <p>Most pts were admitted through the emergency department (49,1%). The main cause for initiating levosimendan infusion was decompensated HF (NYHA class 4). 18.9% were in cardiogenic shock. Previously to administration, the mean systolic blood pressure (SBP) was 99±15mmHg, mean creatinine (Cr): 1.7±0,9 mg/dL and mean NTproBNP: 9840±9143 pg/mL.</p> <p>Levosimendan was administered as a 24h infusion and 54% of pts tolerated a dose titration up to 0,2mcg/kg/min. 29 pts required concomitant dobutamine treatment and 14% required vasopressor therapy. 7 pts had adverse effects: 5 severe hypotension and 2 hepatotoxicity. </p> <p>After levosimendan perfusion, we found a significant reduction on Cr value (1,7 vs 1,2 p<0.001), NT-proBNP value (9840 vs 5116 p< 0,001) and number of hospitalizations (1 vs 2 p=0,004). Most pts improved to NYHA class 3 and 22% presented an improvement of LVEF of at least 5%.21% of pts died during hospitalization and 43,4% died in the next 12 months. For our population, the 12 months mortality predictors were: concomitant dobutamine treatment (HR: 3.6 p<0.001), number of days of hospitalization prior to the infusion (HR: 1,03, p=0,022), initial LVEF value (HR: 1,06 p=0,021) and absence of NYHA class improvement, especially maintenance in NYHA class IV (HR:1,8 p=0,008 and HR 3,6 p=0.003, respectively). </p> <p><strong>Conclusion: </strong>Treatment of levosimendan was safe and associated with a clinical and analytic improvement, namely Cr and NTproBNP reduction as well as reduced number of hospitalizations. However, the mortality rate remains a major challenge in these pts. </p>
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