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Levosimendan in outpatients with Advanced Heart Failure: Single-Center experience of 200 intermitent perfusions
Session:
Posters (Sessão 3 - Écran 4) - Insuficiência Cardíaca 3 - Terapêutica Farmacológica
Speaker:
António Valentim Gonçalves
Congress:
CPC 2022
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
António Valentim Gonçalves; João Reis; Rita Ilhão Moreira; Tiago Pereira-Da-Silva; Rui Soares; Ana Teresa Timóteo; Delmira Pombo; Tiago Carvalho; Catarina Correia; Cláudia Santos; Rui Cruz Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">Background:</span></span></span></u></strong> </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">Patients with advanced heart failure (AdHF) have a high rate of morbidity and mortality. The use of a 6-hour intermittent outpatient Levosimendan infusion has been proven to give symptomatic relief and lower the rate of HF episodes, allowing patients to be treated without having to be hospitalized. </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">Our aim was to evaluate the safety and efficacy of ambulatory Levosimendan administration in an AdHF population. </span></span></span></span></span></p> <p style="margin-left:47px; text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">Methods:</span></span></span></u></strong> </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">Single center prospective experience of consecutive AdHF referred for</span></span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"> intermittent intravenous outpatient administration of Levosimendan, between January 2018 and March 2021<span style="color:black">. </span>Levosimendan was administered every 2 weeks by a 6-hour intravenous infusion (0.2 </span></span><span style="font-size:12.0pt"><span style="font-family:"Cambria Math",serif">u</span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">g/kg/min) for 12 weeks (6 cycles) in an ambulatory administration setting with non-invasive monitoring of vital signs. Patients in the active Heart Transplant list continued treatment until a donor was available or a significant clinical improvement made the treatment unnecessary. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Patients were deemed eligible if they met all of the following criteria:</span></span> <span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">age>18 years, LVEF ≤ 35%, NYHA functional class ≥III and at least one HF hospitalization in the previous 6 months or severe impairment of exercise capacity (peak oxygen consumption (pVO2) ≤12mL/Kg/min).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">Baseline and follow-up evaluation including clinical assessment, laboratory evaluation, transthoracic echocardiography and cardiopulmonary exercise test (CPET) were collected at baseline and 6 months thereafter (3 months after finishing treatment). The </span></span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">data were compared using the Wilcoxon signed-rank test.</span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">Results:</span></span></span></u></strong> </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">A total of 24 patients (60.8 years, 83% male, mean left ventricular ejection fraction (LVEF) of 24%), with a mean of 1.7 HF hospitalizations in the previous 6 months, were included. During the three-year period, 200 treatments were performed with no serious adverse events reported. </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">At 6-month follow-up there was a significant reduction in HF hospitalizations </span></span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">(1.7</span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">±0.9 </span></span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">to <span style="color:black">0.4</span></span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">±0.7</span></span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">, p</span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"><span style="color:black"><0.001), </span></span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">NYHA Class IV patients (52% to 13%, p=0.025) and NTproBNP (8813±6101 to 5005±4886<span style="color:black">pg/mL, p=0.038). A significant improvement was also noted in </span>pVO2 (12±3 to 14±5 ml/kg/min, p = 0.043) and <span style="color:black">LVEF (</span>24±6% to 29.7±9%, p = 0.008)<span style="color:black">. </span></span></span></span></span></p> <p> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Conclusion</span></span></u></strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">: </span></span></span></span></p> <p><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">6- Hour Levosimendan administration in an outpatient setting to AdHF patients is a safe procedure and was associated with a reduction in HF hospitalizations and NT-proBNP levels, as well as an improvement in functional capacity and LVEF during follow-up.</span></span></span></p>
Slides
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