SPC365

Levosimendan – Single center experience with intermittent 24h administration

Session: Comunicações Orais - Sessão 18 - Insuficiência cardíaca: tratamento
Speaker: Miguel Azaredo Raposo

Congress: CPC 2023
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.4 Chronic Heart Failure – Treatment
Session Type: Comunicações Orais
FP Number: ---
Authors: Miguel Azaredo Raposo; João R. Agostinho; Joana Brito; Beatriz Silva; Rafael Santos; Tatiana Guimarães; Hugo Corte Real; Fausto J.Pinto; Dulce Brito

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><strong>Introduction: </strong>Advanced heart failure (AdHF) remains a challenging condition as effective treatment is restricted to heart transplant (HT) and left ventricle assist devices (LVAD). These therapies lack availability and are contraindicated or deemed futile in a significant number of patients (pts). Intermittent administration of the inodilator Levosimendan is a valuable strategy to reduce acute heart failure admissions and improve quality of life.&nbsp; </span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><strong>Aim:</strong> To describe the experience of a tertiary hospital Heart Failure Unit with the intermittent intravenous (IV) administration of Levosimendan (24-hour infusion period).</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><strong>Methods: </strong>Retrospective, single-centre study. A predefined protocol that suggested monthly administrations of Levosimendan was followed &ndash; Figure 1. At least 3 initial administrations were also suggested. The need for subsequent infusions and the respective schedule was guided by clinical and laboratorial parameters. Clinical, laboratorial and administration schedule data was collected. The year before the first Levosimendan infusion was compared to the following, regarding the number of unprogrammed HF admissions for each pt. One-year HF related mortality rate was estimated using the Seattle Heart Failure Model and was compared to the observed rate in the study population. </span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><strong>Results</strong>: From December 2017 to November 2022, a total of 20 pts underwent intermittent 24-hours Levosimendam administrations. The population had a mean age of 60&plusmn;21y and 80% were male. Ischemic heart disease (10 pts), dilated cardiomyopathy (9 pts) and valvular heart disease (1 pt) were the HF etiologies. Before the first infusion, mean left ventricle ejection fraction (LVEF) was 24% (IQR 24-28.5) and all patients &nbsp;had &nbsp;LVEF &lt; 35%. 17(85%) pts were in NYHA functional class III and 3 (15%) in class IV.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">13(65%) pts were too old or had contraindication for HT or LVAD and 7(35%) were either waiting HT or LVAD or being evaluated for these therapies. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">During a mean follow-up (FUP) time of 20.7&plusmn;15.7 months, mean number of infusions per patient was 6.75&plusmn;5.68. 6 pts had marked clinical improvement and had the protocol withheld after a mean number of 3.2&plusmn;1.5 infusions. 2 of those patients were waiting for HT evaluation which was suspended.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Intermittent administrations led to a reduction in the number of HF hospitalizations (2.35, IQR 1,25-2.75 vs 0.85, IQR 0-1; p= 0.001) during FUP.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Overall mortality rate at the end of FUP was 45%. One pt underwent LVAD implant. The observed 1-year HF related mortality rate was 12.5%, compared to 16% estimated by the Seattle Heart Failure Model. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">No severe adverse events were reported. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><strong>Conclusion:</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">In this single center series of pts with AdHF, despite a doubtful impact in mortality, intermittent 24h Levosimendan administrations led to a significant reduction in HF hospitalizations. Also, a non-negligible proportion of pts actually improved and are stable without the need for advanced therapies. </span></span></p>