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Real world noninvasive evaluation of the acute hemodynamic effects of levosimendan continuous infusion in advanced heart failure patients
Session:
Posters - D. Heart Failure
Speaker:
Inês Fialho
Congress:
CPC 2021
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Posters
FP Number:
---
Authors:
Inês Fialho; João Baltazar Ferreira; Marco Beringuilho; Daniel Faria; João Bicho Augusto; Hilaryano Ferreira; Mariana Passos; Ana Oliveira Soares; David Roque
Abstract
<p style="text-align:justify"><span style="font-size:16px"><span style="color:#000000"><strong>Background: </strong>Intermittent use of levosimendan infusion has been showed to reduce plasma NT-proBNP levels and hospitalizations in advanced heart failure (adHF) patients. Ambulatory levosimendan infusion programs have been used for those who are not candidates for heart transplant and ventricular assist devices or as a bridge to these therapeutic options.</span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="color:#000000"><strong>Objective:</strong> To evaluate the acute hemodynamic effects of levosimendan continuous infusion in adHF patients.</span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="color:#000000"><strong>Methods:</strong> We conducted an unicentric study of consecutive adHF patients with reduced ejection fraction, integrated in the ambulatory intermittent levosimendan infusion program of our Institution, the largest cohort in Portugal (10 patients). Patients were included if: 1) they were in New York Heart Failure Association (NYHA) class II-IV; 2) they were under optimal guideline-directed medical treatment. Patients with acute infections, systolic arterial pressure less than 80 mmHg, severe hepatic or kidney dysfunction were excluded. They received levosimendan by continuous infusion (0,05-0,1 mcg/Kg/min) for 24 hours, with no bolus dose. Vital signs, NT-pro BNP, serum creatinine (sCr), and transthoracic echocardiogram (TTE) were evaluated before and up to 2 hours after the end of infusion. The non-invasive hemodynamic parameters cardiac index (CI), systemic vascular resistance (SVR), and estimated pulmonary artery pressure (PSAP) were evaluated.</span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="color:#000000"><strong>Results</strong>: A total of 10 patients were included. The median age was 67 (58-75) years, 90% were males (n=9). Ischemic HF was present in 50% (n=5) of patients, 40% were in NYHA class III (n=4), and 20% in NYHA class IV (n=2). Most patients were chronically medicated with beta-blockers (n=9, 90%), angiotensin receptor-neprilysin inhibitor (n=6, 60%), mineralocorticoid receptor antagonists (n=8, 80%), and diuretics (100%, n=10). 20% (n=2) received angiotensin-converting enzyme inhibitors, 50% (n=5) received sodium-glucose co-transporter-2 inhibitors, 40% (n=4) had a cardiac resynchronization therapy device, and 40% (n=4) an implantable cardioverter defibrillator. The median NT-pro BNP level was 5995 (IQR 2460-18070) ng/dL. After levosimendan infusion it was observed a significant 34% reduction of NT-proBNP (5995, IQR 2460-18070 ng/dL vs 3933, IQR 1979-8125 ng/dL, <em>p</em>=0.005), a significant reduction of sCr (1,49±0,53 mg/dL vs 1,28±0,52 mg/dL, <em>p </em><0.001), a 22% reduction of PSAP (49, IQR 33-62 mmHg vs 38, IQR 29-52 mmHg, <em>p</em>=0.015), and a significant 30% reduction of SVR (4276, IQR 3401-4816 dynes/seconds/cm<sup>-5 </sup>vs 2974, IQR 2376-3552 dynes/seconds/cm<sup>-5</sup>, <em>p</em>=0.011). The CI presented a significant 21% increase (1.58±0.34 L/min/m<sup>2 </sup>vs 1.91±0,25 L/min/m<sup>2</sup>, <em>p</em>=0.016).</span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="color:#000000"><strong>Conclusions: </strong>Levosimendan infusion improves CI and decreases PSAP, SVR, NT-pro BNP, and sCr levels in real world adHF patients confirming the benefits of ambulatory levosimendan infusion programs in this subgroup of patients.</span></span></p>
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