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Peled Y, Ducharme A, Kittleson M, Bansal N, Stehlik J, Amdani S, Saeed D, Cheng R, Clarke B, Dobbels F, Farr M, Lindenfeld J, Nikolaidis L, Patel J, Acharya D, Albert D, Aslam S, Bertolotti A, Chan M, Chih S, Colvin M, Crespo-Leiro M, D'Alessandro D, Daly K, Diez-Lopez C, Dipchand A, Ensminger S, Everitt M, Fardman A, Farrero M, Feldman D, Gjelaj C, Goodwin M, Harrison K, Hsich E, Joyce E, Kato T, Kim D, Luong ML, Lyster H, Masetti M, Matos LN, Nilsson J, Noly PE, Rao V, Rolid K, Schlendorf K, Schweiger M, Spinner J, Townsend M, Tremblay-Gravel M, Urschel S, Vachiery JL, Velleca A, Waldman G, Walsh J. International Society for Heart and Lung Transplantation Guidelines for the Evaluation and Care of Cardiac Transplant Candidates-2024. J Heart Lung Transplant 2024; 43:1529-1628.e54. [PMID: 39115488 DOI: 10.1016/j.healun.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 08/18/2024] Open
Abstract
The "International Society for Heart and Lung Transplantation Guidelines for the Evaluation and Care of Cardiac Transplant Candidates-2024" updates and replaces the "Listing Criteria for Heart Transplantation: International Society for Heart and Lung Transplantation Guidelines for the Care of Cardiac Transplant Candidates-2006" and the "2016 International Society for Heart Lung Transplantation Listing Criteria for Heart Transplantation: A 10-year Update." The document aims to provide tools to help integrate the numerous variables involved in evaluating patients for transplantation, emphasizing updating the collaborative treatment while waiting for a transplant. There have been significant practice-changing developments in the care of heart transplant recipients since the publication of the International Society for Heart and Lung Transplantation (ISHLT) guidelines in 2006 and the 10-year update in 2016. The changes pertain to 3 aspects of heart transplantation: (1) patient selection criteria, (2) care of selected patient populations, and (3) durable mechanical support. To address these issues, 3 task forces were assembled. Each task force was cochaired by a pediatric heart transplant physician with the specific mandate to highlight issues unique to the pediatric heart transplant population and ensure their adequate representation. This guideline was harmonized with other ISHLT guidelines published through November 2023. The 2024 ISHLT guidelines for the evaluation and care of cardiac transplant candidates provide recommendations based on contemporary scientific evidence and patient management flow diagrams. The American College of Cardiology and American Heart Association modular knowledge chunk format has been implemented, allowing guideline information to be grouped into discrete packages (or modules) of information on a disease-specific topic or management issue. Aiming to improve the quality of care for heart transplant candidates, the recommendations present an evidence-based approach.
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Affiliation(s)
- Yael Peled
- Leviev Heart & Vascular Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel; Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel.
| | - Anique Ducharme
- Deparment of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
| | - Michelle Kittleson
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Neha Bansal
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Josef Stehlik
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Shahnawaz Amdani
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio, USA
| | - Diyar Saeed
- Heart Center Niederrhein, Helios Hospital Krefeld, Krefeld, Germany
| | - Richard Cheng
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Brian Clarke
- Division of Cardiology, University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Fabienne Dobbels
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Maryjane Farr
- Division of Cardiology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX; Parkland Health System, Dallas, TX, USA
| | - JoAnn Lindenfeld
- Division of Cardiovascular Medicine, Vanderbilt University, Nashville, TN, USA
| | | | - Jignesh Patel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Deepak Acharya
- Division of Cardiovascular Diseases, University of Arizona Sarver Heart Center, Tucson, Arizona, USA
| | - Dimpna Albert
- Department of Paediatric Cardiology, Paediatric Heart Failure and Cardiac Transplant, Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Saima Aslam
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Alejandro Bertolotti
- Heart and Lung Transplant Service, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Michael Chan
- University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Sharon Chih
- Heart Failure and Transplantation, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Monica Colvin
- Department of Cardiology, University of Michigan, Ann Arbor, MI; Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Maria Crespo-Leiro
- Cardiology Department Complexo Hospitalario Universitario A Coruna (CHUAC), CIBERCV, INIBIC, UDC, La Coruna, Spain
| | - David D'Alessandro
- Massachusetts General Hospital, Boston; Harvard School of Medicine, Boston, MA, USA
| | - Kevin Daly
- Boston Children's Hospital & Harvard Medical School, Boston, MA, USA
| | - Carles Diez-Lopez
- Advanced Heart Failure and Heart Transplant Unit, Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Anne Dipchand
- Division of Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Melanie Everitt
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Alexander Fardman
- Leviev Heart & Vascular Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel; Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Marta Farrero
- Department of Cardiology, Hospital Clínic, Barcelona, Spain
| | - David Feldman
- Newark Beth Israel Hospital & Rutgers University, Newark, NJ, USA
| | - Christiana Gjelaj
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Matthew Goodwin
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Kimberly Harrison
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eileen Hsich
- Cleveland Clinic Foundation, Division of Cardiovascular Medicine, Cleveland, OH, USA
| | - Emer Joyce
- Department of Cardiology, Mater University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland
| | - Tomoko Kato
- Department of Cardiology, International University of Health and Welfare School of Medicine, Narita, Chiba, Japan
| | - Daniel Kim
- University of Alberta & Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Me-Linh Luong
- Division of Infectious Disease, Department of Medicine, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Haifa Lyster
- Department of Heart and Lung Transplantation, The Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, UK
| | - Marco Masetti
- Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Johan Nilsson
- Department of Cardiothoracic and Vascular Surgery, Skane University Hospital, Lund, Sweden
| | | | - Vivek Rao
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Katrine Rolid
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Kelly Schlendorf
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Joseph Spinner
- Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Madeleine Townsend
- Division of Pediatric Cardiology, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Maxime Tremblay-Gravel
- Deparment of Medicine, Montreal Heart Institute, Université?de Montréal, Montreal, Quebec, Canada
| | - Simon Urschel
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Jean-Luc Vachiery
- Department of Cardiology, Cliniques Universitaires de Bruxelles, Hôpital Académique Erasme, Bruxelles, Belgium
| | - Angela Velleca
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Georgina Waldman
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - James Walsh
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane; Heart Lung Institute, The Prince Charles Hospital, Brisbane, Australia
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2
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Martínez León A, Bazal Chacón P, Herrador Galindo L, Ugarriza Ortueta J, Plaza Martín M, Pastor Pueyo P, Alonso Salinas GL. Review of Advancements in Managing Cardiogenic Shock: From Emergency Care Protocols to Long-Term Therapeutic Strategies. J Clin Med 2024; 13:4841. [PMID: 39200983 PMCID: PMC11355768 DOI: 10.3390/jcm13164841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 08/08/2024] [Accepted: 08/14/2024] [Indexed: 09/02/2024] Open
Abstract
Cardiogenic shock (CS) is a complex multifactorial clinical syndrome of end-organ hypoperfusion that could be associated with multisystem organ failure, presenting a diverse range of causes and symptoms. Despite improving survival in recent years due to new advancements, CS still carries a high risk of severe morbidity and mortality. Recent research has focused on improving early detection and understanding of CS through standardized team approaches, detailed hemodynamic assessment, and selective use of temporary mechanical circulatory support devices, leading to better patient outcomes. This review examines CS pathophysiology, emerging classifications, current drug and device therapies, standardized team management strategies, and regionalized care systems aimed at optimizing shock outcomes. Furthermore, we identify gaps in knowledge and outline future research needs.
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Affiliation(s)
- Amaia Martínez León
- Cardiology Department, Hospital Universitario de Navarra (HUN-NOU), Calle de Irunlarrea, 3, 31008 Pamplona, Spain; (A.M.L.); (P.B.C.); (J.U.O.)
- Navarrabiomed (Miguel Servet Foundation), Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
| | - Pablo Bazal Chacón
- Cardiology Department, Hospital Universitario de Navarra (HUN-NOU), Calle de Irunlarrea, 3, 31008 Pamplona, Spain; (A.M.L.); (P.B.C.); (J.U.O.)
- Navarrabiomed (Miguel Servet Foundation), Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
- Heath Sciences Department, Universidad Pública de Navarra (UPNA-NUP), 31006 Pamplona, Spain
| | - Lorena Herrador Galindo
- Advanced Heart Failure and Cardiology Department, Hospital Universitario de Bellvitge, Carrer de la Feixa Llarga s/n, 08907 L’Hospitalet de Llobregat, Spain;
| | - Julene Ugarriza Ortueta
- Cardiology Department, Hospital Universitario de Navarra (HUN-NOU), Calle de Irunlarrea, 3, 31008 Pamplona, Spain; (A.M.L.); (P.B.C.); (J.U.O.)
- Navarrabiomed (Miguel Servet Foundation), Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
| | - María Plaza Martín
- Cardiology Department, Hospital Clínico Universitario de Valladolid, Av Ramón y Cajal 3, 47003 Valladolid, Spain;
| | - Pablo Pastor Pueyo
- Cardiology Department, Hospital Universitari Arnau de Vilanova, Av Alcalde Rovira Roure, 80, 25198 Lleida, Spain;
| | - Gonzalo Luis Alonso Salinas
- Cardiology Department, Hospital Universitario de Navarra (HUN-NOU), Calle de Irunlarrea, 3, 31008 Pamplona, Spain; (A.M.L.); (P.B.C.); (J.U.O.)
- Navarrabiomed (Miguel Servet Foundation), Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
- Heath Sciences Department, Universidad Pública de Navarra (UPNA-NUP), 31006 Pamplona, Spain
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Ahmad T, Manohar SA, Stencel JD, Le Jemtel TH. Dobutamine in the Management of Advanced Heart Failure. J Clin Med 2024; 13:3782. [PMID: 38999346 PMCID: PMC11242841 DOI: 10.3390/jcm13133782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/16/2024] [Accepted: 06/20/2024] [Indexed: 07/14/2024] Open
Abstract
Background: The potential harm and clinical benefits of inotropic therapy in patients with decompensated heart failure with reduced ejection fraction or advanced heart failure were debated for three decades. Nonetheless, confronted with a dismal quality of life in the last months to years of life, continuous home inotropic therapy has recently gained traction for palliative therapy in patients who are not candidates for left ventricular mechanical circulatory support or heart transplantation. Methods: As continuous inotropic therapy is only considered for patients who experience symptomatic relief and display objective evidence of improvement, clinical equipoise is no longer present, and randomized controlled trials are hard to conduct. Results: We first outline the transient use of inotropic therapy in patients with decompensated heart failure with reduced ejection fraction and emphasize the hemodynamic requisite for inotropic therapy, which is a demonstration of a low cardiac output through a low mixed venous oxygen saturation. Lastly, we review the current experience with the use of home inotropic therapy in patients who are not candidates or are awaiting mechanical circulatory support or heart transplantation. Conclusions: Evidence-based clinical data are needed to guide inotropic therapy for refractory decompensated heart failure with reduced ejection fraction in patients who are ineligible or awaiting mechanical circulatory support or heart transplantation.
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Affiliation(s)
- Tanjeev Ahmad
- John W. Deming Department of Medicine Tulane University, 131 S., New Orleans, LA 70112, USA
| | - Shamitha A Manohar
- John W. Deming Department of Medicine Tulane University, 131 S., New Orleans, LA 70112, USA
| | - Jason D Stencel
- John W. Deming Department of Medicine Tulane University, 131 S., New Orleans, LA 70112, USA
| | - Thierry H Le Jemtel
- John W. Deming Department of Medicine Tulane University, 131 S., New Orleans, LA 70112, USA
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Goirigolzarri-Artaza J, Restrepo-Córdoba MA. Levosimendan as a bridge to heart transplant: a real alternative. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:302-303. [PMID: 38104926 DOI: 10.1016/j.rec.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/01/2023] [Indexed: 12/19/2023]
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Riccardi M, Pagnesi M, Chioncel O, Mebazaa A, Cotter G, Gustafsson F, Tomasoni D, Latronico N, Adamo M, Metra M. Medical therapy of cardiogenic shock: Contemporary use of inotropes and vasopressors. Eur J Heart Fail 2024; 26:411-431. [PMID: 38391010 DOI: 10.1002/ejhf.3162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/23/2024] [Accepted: 01/28/2024] [Indexed: 02/24/2024] Open
Abstract
Cardiogenic shock is a primary cardiac disorder that results in both clinical and biochemical evidence of tissue hypoperfusion and can lead to multi-organ failure and death depending on its severity. Inadequate cardiac contractility or cardiac power secondary to acute myocardial infarction remains the most frequent cause of cardiogenic shock, although its contribution has declined over the past two decades, compared with other causes. Despite some advances in cardiogenic shock management, this clinical syndrome is still burdened by an extremely high mortality. Its management is based on immediate stabilization of haemodynamic parameters so that further treatment, including mechanical circulatory support and transfer to specialized tertiary care centres, can be accomplished. With these aims, medical therapy, consisting mainly of inotropic drugs and vasopressors, still has a major role. The purpose of this article is to review current evidence on the use of these medications in patients with cardiogenic shock and discuss specific clinical settings with indications to their use.
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Affiliation(s)
- Mauro Riccardi
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Matteo Pagnesi
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', Bucharest, Romania
| | - Alexandre Mebazaa
- Université Paris Cité, Inserm MASCOT, AP-HP Department of Anesthesia and Critical Care, Hôpital Lariboisière, Paris, France
| | | | - Finn Gustafsson
- Heart Centre, Department of Cardiology, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark
| | - Daniela Tomasoni
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Nicola Latronico
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Department of Anesthesia, Intensive Care and Emergency, ASST Spedali Civili University Hospital, Brescia, Italy
| | - Marianna Adamo
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Metra
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Silvetti S, Pollesello P, Belletti A. Repeated Levosimendan Infusions in the Management of Advanced Heart Failure: Review of the Evidence and Meta-analysis of the Effect on Mortality. J Cardiovasc Pharmacol 2024; 83:144-157. [PMID: 37991393 PMCID: PMC10842679 DOI: 10.1097/fjc.0000000000001506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/23/2023] [Indexed: 11/23/2023]
Abstract
ABSTRACT In the latest years, several studies described the impact of repetitive/intermittent i.v. levosimendan treatment in the management of advanced heart failure. For this updated review, we systematically searched the literature for clinical trials, registries , and real-world data and identified 31 studies that we commented in a narrative review: 3814 patients were described, of whom 1744 were treated repetitively with levosimendan. On the basis of the nature of the study protocols and of the end points, out of those studies, we further selected 9 that had characteristics, making them suitable for a meta-analysis on mortality. This short list describes data from 680 patients (of whom 399 received repeated doses of levosimendan) and 110 death events (of which 50 occurred in the levosimendan cohort). In the meta-analysis, repetitive/intermittent therapy with i.v. levosimendan was associated with a significant reduction in mortality at the longest time point available: 50 of 399 (12.5%) versus 60 of 281 (21.4%) in the control arms, with a risk ratio of 0.62 (95% confidence interval, 0.42-0.90; P < 0.01). In a sensitivity analysis, removing each trial and reanalyzing the remaining data set did not change the trend, magnitude, or significance of the results. A visual inspection of the funnel plot did not suggest publication bias. The results provide a very strong rationale for continuing to investigate the repetitive use of levosimendan in patients with advanced heart failure by properly powered regulatory clinical trials. Meanwhile, it seems that the use of repetitive/intermittent i.v. levosimendan infusions has become one of the few effective options for preserving the hemodynamic and symptomatic balance in such patients.
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Affiliation(s)
- Simona Silvetti
- Neonatal and Pediatric Intensive Care Unit, Department of Critical Care and Perinatal Medicine, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | | | - Alessandro Belletti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
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7
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Acosta-Armas P, Medina-Gil JM, Martínez-Quintana E. [Effect of outpatient administration of levosimendan in reducing hospital readmission in patients with heart failure]. Med Clin (Barc) 2023; 161:403-404. [PMID: 37598053 DOI: 10.1016/j.medcli.2023.06.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 06/25/2023] [Accepted: 06/27/2023] [Indexed: 08/21/2023]
Affiliation(s)
- Paula Acosta-Armas
- Departamento de Ciencias Médicas y Quirúrgicas, Facultad de Ciencias de la Salud, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - José María Medina-Gil
- Servicio de Cardiología. Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, España
| | - Efrén Martínez-Quintana
- Departamento de Ciencias Médicas y Quirúrgicas, Facultad de Ciencias de la Salud, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España; Servicio de Cardiología. Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, España.
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Codina P, Dobarro D, de Juan‐Bagudá J, De Frutos F, Lupón J, Bayes‐Genis A, Gonzalez‐Costello J. Heart failure risk scores in advanced heart failure patients: insights from the LEVO-D registry. ESC Heart Fail 2023; 10:2875-2881. [PMID: 37991427 PMCID: PMC10567651 DOI: 10.1002/ehf2.14400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/05/2023] [Accepted: 05/02/2023] [Indexed: 11/23/2023] Open
Abstract
AIMS The prevalence of advanced heart failure (HF) is increasing due to the growing number of patients with HF and their better treatment and survival. There is a scarcity of data on the accuracy of HF web-based risk scores in this selected population. This study aimed to assess mortality prediction performance of the Meta-Analysis Global Group in Chronic HF (MAGGIC-HF) risk score and the model of the Barcelona Bio-HF Risk Calculator (BCN-Bio-HF) containing N terminal pro brain natriuretic peptide in HF patients receiving intermittent inotropic support with levosimendan as destination therapy. METHODS AND RESULTS Four hundred and three advanced HF patients from 23 tertiary hospitals in Spain receiving intermittent inotropic support with levosimendan as destination therapy were included. Discrimination for all-cause mortality was compared by area under the curve (AUC) and Harrell's C-statistic at 1 year. Calibration was assessed by calibration plots comparing observed versus expected events based on estimated risk by each calculator. The included patients were predominantly men, aged 71.5 [interquartile range 64-78] years, with reduced left ventricular ejection fraction (27.5 ± 9.4%); ischaemic heart disease was the most prevalent aetiology (52.5%). Death rate at 1 year was 26.8%, while the predicted 1-year mortality by BCN-Bio-HF and MAGGIC-HF was 17.0% and 22.1%, respectively. BCN-Bio-HF AUC was 0.66 (Harrell's C-statistic 0.64), and MAGGIC-HF AUC was 0.62 (Harrell's C-statistic 0.61). CONCLUSIONS The two evaluated risk scores showed suboptimal discrimination and calibration with an underestimation of risk in advanced HF patients receiving levosimendan as destination therapy. There is a need for specific scores for advanced HF.
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Affiliation(s)
- Pau Codina
- Hospital Universitari Germans Trias i PujolBadalonaSpain
- Department of MedicineUniversitat Autonoma de BarcelonaBarcelonaSpain
| | - David Dobarro
- Hospital Álvaro Cunqueiro. Complexo Hospitalario Universitario de VigoVigoSpain
| | - Javier de Juan‐Bagudá
- Department of CardiologyUniversity Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12)MadridSpain
- Department of Medicine, Faculty of Biomedical and Health ScienceUniversidad Europea de MadridMadridSpain
- CIBERCV, Instituto de Salud Carlos IIIMadridSpain
| | - Fernando De Frutos
- Department of Cardiology, Hospital Universitari de Bellvitge, BIOHEART‐Cardiovascular Diseases Research GroupBellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LlobregatBarcelonaSpain
| | - Josep Lupón
- Hospital Universitari Germans Trias i PujolBadalonaSpain
- Department of MedicineUniversitat Autonoma de BarcelonaBarcelonaSpain
- CIBERCV, Instituto de Salud Carlos IIIMadridSpain
| | - Antoni Bayes‐Genis
- Hospital Universitari Germans Trias i PujolBadalonaSpain
- Department of MedicineUniversitat Autonoma de BarcelonaBarcelonaSpain
- CIBERCV, Instituto de Salud Carlos IIIMadridSpain
| | - José Gonzalez‐Costello
- CIBERCV, Instituto de Salud Carlos IIIMadridSpain
- Department of Cardiology, Hospital Universitari de Bellvitge, BIOHEART‐Cardiovascular Diseases Research GroupBellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LlobregatBarcelonaSpain
- Department of Clinical Sciences, School of MedicineUniversitat de BarcelonaBarcelonaSpain
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9
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Cholley B, Bojan M, Guillon B, Besnier E, Mattei M, Levy B, Ouattara A, Tafer N, Delmas C, Tonon D, Rozec B, Fellahi JL, Lim P, Labaste F, Roubille F, Caruba T, Mauriat P. Overview of the current use of levosimendan in France: a prospective observational cohort study. Ann Intensive Care 2023; 13:69. [PMID: 37552372 PMCID: PMC10409690 DOI: 10.1186/s13613-023-01164-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/11/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Following the results of randomized controlled trials on levosimendan, French health authorities requested an update of the current use and side-effects of this medication on a national scale. METHOD The France-LEVO registry was a prospective observational cohort study reflecting the indications, dosing regimens, and side-effects of levosimendan, as well as patient outcomes over a year. RESULTS The patients included (n = 602) represented 29.6% of the national yearly use of levosimendan in France. They were treated for cardiogenic shock (n = 250, 41.5%), decompensated heart failure (n = 127, 21.1%), cardiac surgery-related low cardiac output prophylaxis and/or treatment (n = 86, 14.3%), and weaning from veno-arterial extracorporeal membrane oxygenation (n = 82, 13.6%). They received 0.18 ± 0.07 µg/kg/min levosimendan over 26 ± 8 h. An initial bolus was administered in 45 patients (7.5%), 103 (17.1%) received repeated infusions, and 461 (76.6%) received inotropes and or vasoactive agents concomitantly. Hypotension was reported in 218 patients (36.2%), atrial fibrillation in 85 (14.1%), and serious adverse events in 17 (2.8%). 136 patients (22.6%) died in hospital, and 26 (4.3%) during the 90-day follow-up. CONCLUSIONS We observed that levosimendan was used in accordance with recent recommendations by French physicians. Hypotension and atrial fibrillation remained the most frequent side-effects, while serious adverse event potentially attributable to levosimendan were infrequent. The results suggest that this medication was safe and potentially associated with some benefit in the population studied.
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Affiliation(s)
- Bernard Cholley
- Department of Anaesthesiology and Intensive Care Medicine, Hôpital Européen Georges Pompidou, AP-HP, 75015, Paris, France.
- Université Paris Cité, INSERM, UMR_S 1140 "Innovations Thérapeutiques en Hémostase", 75006, Paris, France.
| | - Mirela Bojan
- Pôle Cardiopathies Congénitales, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, 92350, Le Plessis-Robinson, France
| | - Benoit Guillon
- Department of Cardiology, University Hospital Besancon, Besançon, France
| | - Emmanuel Besnier
- Department of Anaesthesiology and Critical Care, Normandie Univ, UNIROUEN, INSERM U1096, CHU Rouen, 76000, Rouen, France
| | - Mathieu Mattei
- Department of Cardiology and Cardiac Surgery, CHRU de Nancy, Hôpital de Brabois, Vandoeuvre-les Nancy, France
| | - Bruno Levy
- CHRU Nancy, Critical Care, CHRU de Nancy, Hôpital de Brabois, Vandoeuvre-Les Nancy, France
| | - Alexandre Ouattara
- Department of Cardiovascular Anesthesia and Critical Care, CHU Bordeaux, CHU de Bordeaux, 33000, Bordeaux, France
- Biology of Cardiovascular Diseases, Université de Bordeaux, INSERM, U1034, 33600, Pessac, France
| | - Nadir Tafer
- Department of Cardiovascular Anesthesia and Critical Care, CHU Bordeaux, CHU de Bordeaux, 33000, Bordeaux, France
- Biology of Cardiovascular Diseases, Université de Bordeaux, INSERM, U1034, 33600, Pessac, France
| | - Clément Delmas
- Cardiology Department, Rangueil University Hospital, Toulouse, France
| | - David Tonon
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, AP-HM, Aix-Marseille University, 13385, Marseille CEDEX 05, France
| | - Bertrand Rozec
- Department of Anaesthesiology and Critical Care, Institut du Thorax, Laennec Hospital, CHU de Nantes, and Nantes Université, CHU Nantes*, CNRS, INSERM, 44000, Nantes, France
| | - Jean-Luc Fellahi
- Department of Cardiothoracic Anaesthesiology and Critical Care, Louis Pradel University Hospital, Lyon, France
| | - Pascal Lim
- Cardiology department, Henri-Mondor University Hospital, AP-HP, Créteil, France
| | - François Labaste
- Department of Anaesthesiology and Critical Care Medicine, Rangueil University Hospital, Toulouse, France
| | - François Roubille
- Cardiology Department INI-CRT PhyMedExp INSERM, CNRS CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Thibaut Caruba
- Department of Pharmacy, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Philippe Mauriat
- Department of Cardiovascular Anesthesia and Critical Care, CHU Bordeaux, CHU de Bordeaux, 33000, Bordeaux, France
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10
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Dobarro D, Donoso‐Trenado V, Solé‐González E, Moliner‐Abós C, Garcia‐Pinilla JM, Lopez‐Fernandez S, Ruiz‐Bustillo S, Diez‐Lopez C, Castrodeza J, Méndez‐Fernández AB, Vaqueriza‐Cubillo D, Cobo‐Marcos M, Tobar J, Sagasti‐Aboitiz I, Rodriguez M, Escolar V, Abecia A, Codina P, Gómez‐Otero I, Pastor F, Marzoa‐Rivas R, González‐Babarro E, de Juan‐Baguda J, Melendo‐Viu M, de Frutos F, Gonzalez‐Costello J. Intermittent inotropic support with levosimendan in advanced heart failure as destination therapy: The LEVO-D registry. ESC Heart Fail 2023; 10:1193-1204. [PMID: 36655614 PMCID: PMC10053278 DOI: 10.1002/ehf2.14278] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 11/15/2022] [Accepted: 12/16/2022] [Indexed: 01/20/2023] Open
Abstract
AIM 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. METHODS AND RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- David Dobarro
- Hospital Álvaro Cunqueiro, Complexo Hospitalario Universitario de VigoVigoSpain
| | | | | | | | - José Manuel Garcia‐Pinilla
- Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Ciber‐Cardiovascular, Instituto de Salud Carlos III, Departamento de Medicina y Dermatología, Universidad de MálagaMalagaSpain
| | | | | | - Carles Diez‐Lopez
- Hospital General Universitario Gregorio MarañónMadridSpain
- Hospital Universitari de Bellvitge ‐ BIOHEART Research IDIBELLHospitalet del LlobregatBarcelonaSpain
| | | | | | | | - Marta Cobo‐Marcos
- Hospital Universitario Puerta de Hierro, IDIPHISA, Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV)MadridSpain
| | - Javier Tobar
- Hospital Clínico Universitario de ValladolidValladolidSpain
| | | | | | | | | | - Pau Codina
- Hospital Germans Trias i PujolBadalonaSpain
| | - Inés Gómez‐Otero
- Complexo Hospitalario Universitario de SantiagoSantiago de CompostelaSpain
| | | | | | - Eva González‐Babarro
- Hospital de Montecelo, Complexo Hospitalario Universitario de PontevedraPontevedraSpain
| | - Javier de Juan‐Baguda
- Hospital Universitario 12 de Octubre, IMAS12, Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Departamento de Medicina, Facultad de ciencias biomédicas y de la salud, Universidad Europea de MadridMadridSpain
| | - María Melendo‐Viu
- Hospital Álvaro Cunqueiro, Complexo Hospitalario Universitario de VigoVigoSpain
| | - Fernando de Frutos
- Hospital Universitario Puerta de Hierro, IDIPHISA, Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV)MadridSpain
| | - José Gonzalez‐Costello
- Hospital General Universitario Gregorio MarañónMadridSpain
- Hospital Universitari de Bellvitge ‐ BIOHEART Research IDIBELLHospitalet del LlobregatBarcelonaSpain
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