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Association Between Impaired Kidney Function and Worse Response to Levosimendan Treatment
Session:
Sessão de Posters 40 - Insuficiência cardíaca - da Preservada ao Transplante
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:
Filipa Gerardo; Mariana Passos; Inês Fialho; Ana Oliveira Soares; Carolina Mateus; Inês Miranda; Mara Sarmento; Joana Lima Lopes; David Roque
Abstract
<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt">Background</span></strong><span style="font-size:11.0pt">: Kidney dysfunction is a hallmark of advanced heart failure that correlates with morbidity and mortality. Levosimendan is a positive inotropic agent with calcium sensitizing properties that has been reported to reduce the risk of deterioration of heart failure. Positive effects of levosimendan on renal function have been described. However, data regarding response to intermittent pulses of levosimendan in patients with kidney dysfunction is lacking.</span></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt">Purpose</span></strong><span style="font-size:11.0pt">: To correlate levosimendan response with kidney dysfunction in patients with advanced heart failure.</span></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt">Methods</span></strong><span style="font-size:11.0pt">: In a single center study we retrospectively analyzed data from january 2020 to november 2022 of patients with advanced heart failure. Patients were included if they were on intermittent pulses of levosimendan (0.05–0.1 μg/kg/min over 24) in 4 weeks intervals. Exclusion criteria was not meeting the 6-month follow-up time-frame. Clinical and laboratorial data were collected. Kidney dysfunction was assessed with creatinine levels prior to starting levosimendan pulses. Primary outcome was heart failure decompensation 6 months after starting the program, measured by in-hospital patient admission.</span></span></span></p> <p> </p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt">Results</span></strong><span style="font-size:11.0pt">: A total of 35 electronic medical charts were reviewed. Of these, 29 met the inclusion criteria. The participants consisted of 22% women and 78% men. All patients had a reduced ejection fraction (median 22 [IQR 19-25]%) and 53.1% had biventricular dysfunction. The median duration of the program was 3.75 (IQR 1.9-7.5) months. Before levosimendan pulses the participants had a mean of 1.59 (95% CI 0.98-2.21, SD 1.55) in-hospital admissions for acute heart failure. After starting levosimendan pulses the mean of in-hospital admissions was 0.63 (95%CI 0.23-1.03, SD 1.01, p=0.003). Mean creatinine level was 1.44 (95%CI 1.22-1.65, SD 0.54). Multiple regression analysis, adjusted for heart failure decompensations prior to starting levosimendan pulses, showed that patients with higher levels of creatinine had a worse response to levosimedan, with a higher number meeting the primary endpoint (p=0.006). For every unit increase in creatinine levels, there was a corresponding 0.945 (95% CI 0.303-1.586) times increase in the likelihood of a worse response to levosimendan treatment, taking into account previous heart failure decompensations.</span></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt">Conclusions</span></strong><span style="font-size:11.0pt">: Kidney dysfunction appears to correlate with worse response to levosimendan treatment.</span></span></span></p>
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