Intermittent inotropic support with levosimendan in advanced heart failure as destination therapy: The LEVO-D registry
Por:
Dobarro, D, Donoso-Trenado, V, Sole-Gonzalez, E, Moliner-Abos, C, Garcia-Pinilla, JM, Lopez-Fernandez, S, Ruiz-Bustillo, S, Diez-Lopez, C, Castrodeza, J, Mendez-Fernandez, AB, Vaqueriza-Cubillo, D, Cobo-Marcos, M, Tobar, J, Sagasti-Aboitiz, I, Rodriguez, M, Escolar, V, Abecia, A, Codina, P, Gomez-Otero, I, Pastor, F, Marzoa-Rivas, R, Gonzalez-Babarro, E, de Juan-Baguda, J, Melendo-Viu, M, de Frutos, F, Gonzalez-Costello, J
Publicada:
1 abr 2023
Ahead of Print:
1 ene 2023
Resumen:
AimPatients with advanced heart failure (AHF) who are not candidates to advanced therapies have poor prognosis. Some trials have shown that intermittent levosimendan can reduce HF hospitalizations in AHF in the short term. In this real-life registry, we describe the patterns of use, safety and factors related to the response to intermittent levosimendan infusions in AHF patients not candidates to advanced therapies. Methods and resultsMulticentre retrospective study of patients diagnosed with advanced heart failure, not HT or LVAD candidates. Patients needed to be on the optimal medical therapy according to their treating physician. Patients with de novo heart failure or who underwent any procedure that could improve prognosis were not included in the registry. Four hundred three patients were included; 77.9% needed at least one admission the year before levosimendan was first administered because of heart failure. Death rate at 1 year was 26.8% and median survival was 24.7 [95% CI: 20.4-26.9] months, and 43.7% of patients fulfilled the criteria for being considered a responder lo levosimendan (no death, heart failure admission or unplanned HF visit at 1 year after first levosimendan administration). Compared with the year before there was a significant reduction in HF admissions (38.7% vs. 77.9%; P < 0.0001), unplanned HF visits (22.7% vs. 43.7%; P < 0.0001) or the combined event including deaths (56.3% vs. 81.4%; P < 0.0001) during the year after. We created a score that helps predicting the responder status at 1 year after levosimendan, resulting in a score summatory of five variables: TEER (+2), treatment with beta-blockers (+1.5), Haemoglobin >12 g/dL (+1.5), amiodarone use (-1.5) HF visit 1 year before levosimendan (-1.5) and heart rate >70 b.p.m. (-2). Patients with a score less than -1 had a very low probability of response (21.5% free of death or HF event at 1 year) meanwhile those with a score over 1.5 had the better chance of response (68.4% free of death or HF event at 1 year). LEVO-D score performed well in the ROC analysis. ConclusionIn this large real-life series of AHF patients treated with levosimendan as destination therapy, we show a significant decrease of heart failure events during the year after the first administration. The simple LEVO-D Score could be of help when deciding about futile therapy in this population.
Filiaciones:
Dobarro, D:
Complexo Hosp Univ Vigo, Hosp Alvaro Cunqueiro, Vigo, Spain
Donoso-Trenado, V:
Hosp Univ & Politecn La Fe, Valencia, Spain
Sole-Gonzalez, E:
Hosp Clin Barcelona, Barcelona, Spain
Moliner-Abos, C:
IIB St PAU, Hosp St Creu & St Pau, Barcelona, Spain
Garcia-Pinilla, JM:
Univ Malaga, Hosp Univ Virgen Victoria, IBIMA, Dept Med & Dermatol,Ciber Cardiovasc,Inst Salud Ca, Malaga, Spain
Lopez-Fernandez, S:
Hosp Univ Virgen Nieves, ibs GRANADA, Granada, Spain
Ruiz-Bustillo, S:
Hosp Der Mar, Barcelona, Spain
Diez-Lopez, C:
Hosp Gen Univ Gregorio Maranon, Madrid, Spain
Hosp Univ Bellvitge, BIOHEART Res IDIBELL, Barcelona, Spain
Castrodeza, J:
Hosp Gen Univ Gregorio Maranon, Madrid, Spain
Mendez-Fernandez, AB:
Hosp Univ Vall Hebron, Barcelona, Spain
Vaqueriza-Cubillo, D:
Hosp Univ Infanta Leonor, Hosp Alvaro Cunqueiro, Cardiol Dept, Heart Failure & Pulm Hypertens Unit, Madrid, Spain
Cobo-Marcos, M:
Hosp Univ Puerta Hierro, Ctr Invest Biomed Red Enfermedades Cardiovasc CIBE, IDIPHISA, Madrid, Spain
Tobar, J:
Hosp Clin Univ Valladolid, Valladolid, Spain
Sagasti-Aboitiz, I:
Hosp Univ Cruces, Bizkaia, Spain
Rodriguez, M:
Complejo Hosp Univ Leon, Leon, Spain
Escolar, V:
Hosp Basurto, Bilbao, Spain
Abecia, A:
Hosp Navarra, Pamplona, Spain
Codina, P:
Hosp Germans Trias I Pujol, Badalona, Spain
Gomez-Otero, I:
Complexo Hosp Univ Santiago, Santiago de Compostela, Spain
Pastor, F:
Hosp Univ Virgen Arrixaca, Murcia, Spain
Marzoa-Rivas, R:
Hosp Arquitecto Marcide, Ferrol, Spain
Gonzalez-Babarro, E:
Complexo Hosp Univ Pontevedra, Hosp Montecelo, Pontevedra, Spain
de Juan-Baguda, J:
Univ Europea Madrid, Hosp Univ 12 Octubre, Fac Ciencias Biomedicasy & Salud, Ctr Invest Biomed Red Enfermedades Cardiovasc CIBE, Madrid, Spain
Melendo-Viu, M:
Complexo Hosp Univ Vigo, Hosp Alvaro Cunqueiro, Vigo, Spain
de Frutos, F:
Hosp Univ Puerta Hierro, Ctr Invest Biomed Red Enfermedades Cardiovasc CIBE, IDIPHISA, Madrid, Spain
Gonzalez-Costello, J:
Hosp Gen Univ Gregorio Maranon, Madrid, Spain
Hosp Univ Bellvitge, BIOHEART Res IDIBELL, Barcelona, Spain
gold, Green Published, All Open Access, Gold, Green
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