SPC365

Intermittent levosimendan cycles: a singlecentre clinical experience

Session: Sessão de Posters 38 - Insuficiência cardíaca avançada
Speaker: Mariana Passos

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: Mariana Passos; Filipa Gerardo; Joana Lima Lopes; Carolina Mateus; Inês Miranda; Mara Sarmento; Inês Fialho; Ana Oliveira Soares; David Roque
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Background: </span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Advanced&nbsp;heart&nbsp;failure&nbsp;(AdHF)&nbsp;is&nbsp;characterized&nbsp;by a decline in life expectancy, a poor quality of life marked by frequent hospitalizations, and a significant impairment in functional&nbsp;capacity. In these patients, intermittent levosimendan cycles (ILC) have been shown to have clinical and hemodynamic benefits being used as a bridge therapy, to heart transplantation (HT) and left ventricular assist device (LVAD), or as a symptomatic approach.</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:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Objectives:</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"> To describe the role of ILC in the management of AdHF patients.</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:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Methods: </span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">We performed a retrospective observational analysis of AdHF patients included in an ILC program between <span style="color:black">March 2019 and January 2023. </span>The demographic, clinical, and laboratory data were collected. Levosimendan&nbsp;was&nbsp;infused&nbsp;at&nbsp;0.05-0.2 mg/Kg/min doses&nbsp;without&nbsp;bolus&nbsp;for&nbsp;6h (every two weeks) or 24&nbsp;h (monthly)&nbsp;infusion&nbsp;duration.</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:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Results: </span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">A total of 32 patients were included in the ILC program (58.5 % male; mean age 65.7&plusmn;12.8 years). All patients had a reduced ejection fraction (median 22 [IQR 19-25]%) and 53.1% had biventricular dysfunction. The main HF etiology was ischemic heart disease (56.3%) followed by idiopathic cardiomyopathy (31.3%). At inclusion, 96.9% of patients were in NYHA class III.&nbsp; Relevant demographic and clinical data are summarized in table 1. The median duration of the program was 3.75 [IQR 1.9-7.5] months, and the majority (78.1%) of the patients were in monthly cycles. It was necessary to increase the frequency of administration in 3 patients due to clinical deterioration between the programmed cycles. Only one patient had a ventricular arrhythmia during drug infusion.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">During the 6 months before ILC initiation 22 (68.8%) patients had at least one hospital admission for worsening HF (WHF), and of those 13 (59.1%) had more than one hospitalization, with a median of 2 [IQR 1-3]&nbsp;&nbsp; admissions/patient. For the same length of time after ILC initiation only 10 (40%) patients were&nbsp;hospitalized&nbsp;at&nbsp;least&nbsp;once, 3 (30%), more than one time, with a median of 0 [IQR 0-1] admissions/patient. &nbsp;</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Only twenty-five patients had at least 6 months of follow-up. In these patients after 6 months on ILC there was a significant improvement in NYHA&nbsp;class (p&lt;0.05), reduction in NTproBNP&nbsp;levels (p=0.009), and reduction in HFW&nbsp;admissions (p=0.006).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Until January 2023, 5 patients died and 2 had lost follow-up.&nbsp; 9 are still on the program, 6 for symptom&nbsp;palliation and 3 as a bridge&nbsp;to&nbsp;transplant/LVAD. The treatment was suspended in 15 patients because of clinical improvement, including in 1 that underwent LVAD and in 1 that is on the waiting list for HT. </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:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Conclusion:</span></span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">ILC is an&nbsp;effective&nbsp;and&nbsp;safe&nbsp;option&nbsp;in&nbsp;AdHF, as a palliative approach with an improvement of quality of life, by improving NYHA&nbsp;class and reducing HFW admissions. As well as maintaining the patient&#39;s stability until transplantation or LVAD.</span></span></span></span></p>