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NTproBNP is not a good prognostic marker in patients with advanced heart failure on ambulatory levosimendan infusion program
Session:
Sessão de Posters 18 - Insuficiência cardíaca - Fatores preditores
Speaker:
Ana Filipa Mesquita Gerardo
Congress:
CPC 2024
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.6 Chronic Heart Failure - Clinical
Session Type:
Cartazes
FP Number:
---
Authors:
Ana Filipa Mesquita Gerardo; Mariana Passos; Inês Fialho; Ana Oliveira Soares; Carolina Mateus; Inês Miranda; Joana Lima Lopes; Mara Sarmento; David Roque
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Background:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"> Intermittent levosimendan infusions have been shown to reduce heart failure (HF) hospitalizations in advanced heart failure (ADHF) patients (pts) including those who are not candidates for ADHF therapies.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Purpose:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"> Assess the prognostic value of NTproBNP variations in ADHF pts undergoing intermittent levosimendan infusion.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Methods:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"> Prospective registry of ADHF pts in a single-center ambulatory levosimendan program (May 2020 to Dec 2022). Inclusion criteria were <span style="color:black">HF with reduced ejection fraction (HFrEF) and recurrent HF hospitalizations or sustained clinical decline (NYHA ≥3, progressive intolerance to medical therapy or escalating diuretic dose). Levosimendan was administered as a 24-hour monthly infusion. </span>NTproBNP levels before program initiation and after 1, 3, 6, and 9 months were registered, as well as NTproBNP variation immediately before and after levosimendan infusion (</span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Δ</span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"> NTproBNP).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Results:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"> 32<strong> </strong>pts were included, 75% males (n=24), mean age of 65.8 </span></span><span style="font-size:11.0pt"><span style="font-family:Symbol">±</span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"> 12.8 years. All pts had HFrEF, 56.3% (n=18) of ischemic etiology. At admission, 96.9% (n=31) was in NYHA class 3 and 3.1% (n=1) in NYHA class 4. Median NTproBNP level before levosimendan initiation was 7004 (IQR 3079 – 13254) pg/mL. Levosimendan program significantly reduced HF hospitalizations at 6 months (median 1 [IQR 0-2] vs 0 [IQR 0-1], p=0.005). Median NTproBNP levels significantly decreased after the 1<sup>st</sup> month of therapy (7004 [IQR 3079 – 13254] vs 3720 [IQR 2571 – 6988], p=0.04), and remained stable afterwards (Figure 1). Median NTproBNP decreased after each levosimendan infusion, but </span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Δ</span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"> NTproBNP was not different over time (median </span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Δ</span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"> NTproBNP at 1 month -988 [IQR -2139 – 179] pg/mL, at 3 months -1771 [IQR -2435 – -97] pg/mL, at 6 months -420 [-2136 – 258] pg/mL, p=0.287). Positive </span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Δ</span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"> NTproBNP variation after levosimendan infusion occurred in 31.6% [n=6] of pts at 1 month and 30.0% [n=3] at 6 months but was not a predictor of HF hospitalizations (OR=2.8, CI 95 0.2 – 40, p=0.448). Absolute NTproBNP values at 3, 6 and 9 months were not independent predictors of stable HF and subsequent levosimendan program interruption (OR=1.00, CI 95 0.9 – 1.0, p=0.715). </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Conclusions:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"> NTproBNP is not a good prognostic marker in ADHF on levosimendan intermittent infusion program and should not be used alone for decision of program discontinuation. The decrease and stabilization of NTproBNP initiation of the levosimendan program reflects disease stability, demonstrated by the reduction in HF hospitalizations.</span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"> </p> <p style="text-align:justify"> </p>
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