Intermittent inotropic support with levosimendan in advanced heart failure as destination therapy : The LEVO-D registry
Dobarro, David (Hospital Álvaro Cunqueiro (Vigo))
Donoso-Trenado, Víctor (Hospital Universitari i Politècnic La Fe (València))
Solé González, Eduard (Hospital Clínic i Provincial de Barcelona)
Moliner-Abós, Carles (Institut d'Investigació Biomèdica Sant Pau)
Garcia-Pinilla, José Manuel (Universidad de Málaga)
Lopez-Fernandez, Silvia (Hospital Universitario Virgen de las Nieves (Granada))
Ruiz Bustillo, Sonia (Hospital del Mar (Barcelona, Catalunya))
Díez-López, Carles (Hospital Universitari de Bellvitge)
Castrodeza, Javier (Hospital General Universitario Gregorio Marañón)
Méndez-Fernández, Ana B. (Hospital Universitari Vall d'Hebron)
Vaqueriza-Cubillo, David (Hospital Universitario Infanta Leonor)
Cobo-Marcos, M (Hospital Universitario Puerta de Hierro Majadahonda (Madrid))
Tobar, Javier (Hospital Clínico Universitario de Valladolid)
Sagasti-Aboitiz, Igor (Hospital Universitario de Cruces (Barakaldo, País Basc))
Rodriguez, Miguel (Complejo Hospitalario Universitario de León)
Escolar, Vanessa (Hospital Universitario de Basurto (Bilbao, Biscaia))
Abecia, Ana (Complejo Hospitalario de Navarra)
Codina, Pau (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Gómez-Otero, Inés (Complexo Hospitalario Universitario de Santiago)
Pastor, Francisco (Hospital Clínico Universitario Virgen de la Arrixaca (El Palmar, Múrcia))
Marzoa-Rivas, Raquel (Hospital Arquitecto Marcide)
González-Babarro, Eva (Hospital de Montecelo)
de Juan-Baguda, Javier (Hospital 12 de Octubre (Madrid))
Melendo-Viu, María (Hospital Álvaro Cunqueiro (Vigo))
de Frutos, Fernando (Hospital Universitario Puerta de Hierro Majadahonda (Madrid))
Gonzalez-Costello, José (Hospital Universitari de Bellvitge)
Universitat Autònoma de Barcelona

Data:	2023
Resum:	Patients 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. Multicentre 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. In 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.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Advanced heart failure ; Inotropes ; Levosimendan ; Palliative care
Publicat a:	ESC Heart Failure, Vol. 10 Núm. 2 (april 2023) , p. 1193-1204, ISSN 2055-5822

DOI: 10.1002/ehf2.14278
PMID: 36655614

12 p, 561.9 KB

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Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut de Recerca Sant Pau
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