SPC365

Hemodynamic effects of outpatient levosimendan infusion assessed daily using the invasive remote monitoring CardioMEMS™ system

Session: Posters (Sessão 5 - Écran 2) - Insuficiência cardíaca - tratamento farmacológico
Speaker: Ana Rita Teixeira

Congress: CPC 2023
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.4 Chronic Heart Failure – Treatment
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Ana Rita Teixeira; Tiago Pereira-Da-Silva; António Valentim Gonçalves; Rita Ilhão Moreira; Vera Ferreira; João Alves; Sofia Barquinha; Ana Teresa Timóteo; Rui Cruz Ferreira
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Background:</span></span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black"> Levosimendan infusion with adjusted dosing has been used in the outpatient setting to improve patient status of patients with heart failure (HF). However, the hemodynamic effects of levosimendan are not known in such clinical context. Remote invasive monitoring using the CardioMEMS&trade; system allows for daily assessment of pulmonary artery pressure (PAP) and cardiac output (CO). We aimed to assess the hemodynamic effects of levosimendan in the outpatient setting using the CardioMEMS&trade;.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="color:black">Methods:</span></span></strong><span style="font-size:11.0pt"><span style="color:black"> All patients </span></span><span style="font-size:11.0pt"><span style="background-color:white"><span style="color:black">admitted for outpatient 6-hour levosimendan infusion (which was performed every 14 days in each patient) and with active remote monitoring based on the CardioMEMS&trade; system were included in a </span></span></span><span style="font-size:11.0pt"><span style="color:black">prospective single-center registry. Clinical and laboratory data were recorded. The </span></span><span style="font-size:11.0pt"><span style="color:black">systolic, diastolic, and mean PAP, heart rate (HR) and CO were assessed using CardioMEMS&trade;, from the day prior to each <span style="background-color:white">levosimendan </span>infusion up to the day prior to the next. The hemodynamic data were compared.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Results:</span></span></span></span></strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black"> A total of 25 sessions</span></span></span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black"> were performed in 3 patients (mean age 60</span></span></span><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#202124">&plusmn;22</span></span></span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black"> years, 100% male, 100% in INTERMACS 4, mean left ventricular ejection fraction 28</span></span></span><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#202124">&plusmn;7</span></span></span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">%, mean NTProBNP 10803pg/ml). There were no infusion-related adverse events, HF decompensations or significant changes in diuretic or neuro-hormonal modulatory therapy during the study period. There was a significant reduction in diastolic PAP in the day after levosimendan compared to the prior day (baseline) (24.</span></span></span><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:#202124">1&plusmn;4.1 vs 21.6&plusmn;2.9mmHg, p=0.006</span></span></span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">) (Figure1). Thereafter, the diastolic PAP pressure stabilized, with significant differences in diastolic PAP values up to day </span></span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">7 <span style="color:black">compared to baseline. There were no significant differences in systolic or mean PAP values before and after levosimendan at any timepoint analyzed. There were no differences in CO in the first days after levosimendan compared to baseline; however, there was a CO peak at day 6 after the infusion, consisting of a nonsignificant increased CO compared to baseline (4.0 vs 3.8, p=0.105), followed by a decline. There were no significant differences in HR.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Conclusion</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">: Outpatient <span style="background-color:white"><span style="color:black">levosimendan infusion was associated with an early and sustained reduction in diastolic PAP (a surrogate of left filing pressures) in the first week and may be accompanied by a later increase of CO. The CardioMEMS&trade; system may allow for a better understanding of outpatient hemodynamics in advanced HF. To our knowledge, there are no published data on this subject.</span></span></span></span></span></span></p>