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A. Basics
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01. History of Cardiology
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05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
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23. Peripheral Vascular and Cerebrovascular Disease
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30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
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34. Public Health and Health Economics
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Levosimendan in acute heart failure: a tertiary center experience
Session:
Painel 2 - Insuficiência Cardíaca 10
Speaker:
Mariana Ribeiro Silva
Congress:
CPC 2020
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.4 Acute Heart Failure– Treatment
Session Type:
Posters
FP Number:
---
Authors:
Mariana Ribeiro Da Silva; Gualter Santos Silva; Daniel Caeiro; Marisa Passos Silva; Cláudio Guerreiro; Pedro Gonçalves Teixeira; Pedro Ribeiro Queirós; Mariana S. Brandão; Diogo Ferreira; Olga Sousa; Adelaide V. Dias; Alberto Rodrigues; Pedro Braga
Abstract
<p><strong>Introduction:</strong> Levosimendan (LVS) is a calcium sensitizer and inodilator used for treatment of acute heart failure (HF). It has favorable effects on systemic hemodynamics with an acceptable safety profile.</p> <p><strong>Objectives:</strong> To characterize patients (pts) treated with LVS during hospital stay, to evaluate its effects on hemodynamics and renal function (RF) and the impact of adverse events (AE) in the outcomes.</p> <p><strong>Methods:</strong> Retrospective study that included pts with acute decompensated HF treated with LVS in a cardiac intensive care unit and cardiology ward of a tertiary center, between January 2015 and June 2018. Serum creatinine (SCr) and natriuretic peptides (NT pro-BNP) before and within 5 days after LVS were recorded as well as AE that occurred during infusion. We evaluate outcomes at 1-year.</p> <p><strong>Results and discussion:</strong> 83 LSV infusions were identified in 69 pts, 84% males, mean age 65 years, 49% with ischemic heart disease, left ventricle ejection fraction (EF) ≤40% in 78%. INTERMACS 4 and hemodynamic profile C were the most frequent presentation. LSV was administered in 24h, without bolus, in most pts. 26,1% of pts needed another inotropic or vasopressor and 4,3% needed mechanical assist device.</p> <p>There was a significant improvement in NT-proBNP (10466 to 8237 pg/mL, p=0,012) and SCr (1,62 to 1,44 mg/dL, p=0,001) after LVS use. Also, pts with an EF ≤ 35% significantly improved EF after LVS (21% to 27%, p=0,020). AE were common (37,7%), the most frequent were <em>de novo</em> hypotension, hypokalemia and arrythmias. The majority of AE were easily managed and did not required stopping the infusion. However, in 5 pts (7,2%) infusion need to be stopped due to ventricular arrhythmias. Despite the AE recorded, there was still a significant improvement in RF in this pts (SCr 1,79 to 1,44 mg/dL, p<0,001) but no improvement in NT-proBNP (p=0,156). However, pts who interrupted the infusion prematurely did not significantly improve RF or NT-proBNP (p>0,05 for all).</p> <p>30-day and 1-year mortality was 23,2% and 46,4%. 30-day and 6-month readmissions for cardiovascular cause were 7,4% and 36%. 24,5% pts needed another LSV treatment within the readmissions. It is noteworthy that were no significant differences in mortality nor readmissions at 30-days and 1-year in pts with AE.</p> <p><strong>Conclusion:</strong> LVS improved NT-proBNP, RF and EF. Although AE were frequent, they were well tolerated and they did not change the outcome. Despite this, mortality remained very high.</p>
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