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Masarone D, Kittleson MM, Martucci ML, Valente F, Gravino R, Verrengia M, Ammendola E, Contaldi C, Di Palma V, Caiazzo A, Petraio A, Pollesello P, Pacileo G. Levosimendan as a "Bridge to Optimization" in Patients with Advanced Heart Failure with Reduced Ejection-A Single-Center Study. J Clin Med 2022; 11:jcm11144227. [PMID: 35887992 PMCID: PMC9317236 DOI: 10.3390/jcm11144227] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/02/2022] [Accepted: 07/19/2022] [Indexed: 12/11/2022] Open
Abstract
Background: Patients with advanced heart failure with reduced ejection fraction often cannot tolerate target doses of guideline-directed medical therapy due to symptomatic hypotension, renal dysfunction, and associated electrolyte abnormalities. While levosimendan can facilitate the titration of β-blockers in patients with advanced HFrEF, it is unclear whether ambulatory levosimendan infusions would offer the same benefit. In this prospective study, we investigate the effects of intermittent ambulatory levosimendan infusions on the uptitration of disease-modifying drugs. Methods: We enrolled 37 patients with advanced HFrEF who received repeated ambulatory infusions of levosimendan between January 2018 and January 2021. The demographic, clinical, and laboratory data were acquired 24 h before the first and the last ambulatory levosimendan infusion. Results: At the 1 year follow-up, the enrolled patients were on significantly higher doses of guideline-directed medical therapy, including bisoprolol (3.2 ± 2.8 mg vs. 5.9 ± 4.1 mg; p = 0.02), sacubitril/valsartan (41.67 ± 32.48 mg vs. 68.5 ± 35.72 mg; p = 0.01), and eplerenone (12.7 ± 8.5 mg vs. 22.8 ± 13.6 mg; p = 0.03). Furthermore, a substantial decrease in the furosemide dose was observed (123.2 ± 32.48 mg vs. 81.6 ± 19.47 mg; p < 0.0001). Conclusions: Levosimendan facilitates the optimization of disease-modifying heart failure medications in previously intolerant advanced HFrEF patients.
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Affiliation(s)
- Daniele Masarone
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital Naples, 80131 Naples, Italy; (M.L.M.); (F.V.); (R.G.); (M.V.); (E.A.); (C.C.); (V.D.P.); (G.P.)
- Correspondence: ; Tel.: +39-081-7065163; Fax: +39-081-7062674
| | - Michelle M. Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai, Los Angeles, CA 90048, USA;
| | - Maria L. Martucci
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital Naples, 80131 Naples, Italy; (M.L.M.); (F.V.); (R.G.); (M.V.); (E.A.); (C.C.); (V.D.P.); (G.P.)
| | - Fabio Valente
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital Naples, 80131 Naples, Italy; (M.L.M.); (F.V.); (R.G.); (M.V.); (E.A.); (C.C.); (V.D.P.); (G.P.)
| | - Rita Gravino
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital Naples, 80131 Naples, Italy; (M.L.M.); (F.V.); (R.G.); (M.V.); (E.A.); (C.C.); (V.D.P.); (G.P.)
| | - Marina Verrengia
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital Naples, 80131 Naples, Italy; (M.L.M.); (F.V.); (R.G.); (M.V.); (E.A.); (C.C.); (V.D.P.); (G.P.)
| | - Ernesto Ammendola
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital Naples, 80131 Naples, Italy; (M.L.M.); (F.V.); (R.G.); (M.V.); (E.A.); (C.C.); (V.D.P.); (G.P.)
| | - Carla Contaldi
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital Naples, 80131 Naples, Italy; (M.L.M.); (F.V.); (R.G.); (M.V.); (E.A.); (C.C.); (V.D.P.); (G.P.)
| | - Vito Di Palma
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital Naples, 80131 Naples, Italy; (M.L.M.); (F.V.); (R.G.); (M.V.); (E.A.); (C.C.); (V.D.P.); (G.P.)
| | - Angelo Caiazzo
- Heart Transplant Unit, Department of Cardiac Surgery and Transplant, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (A.C.); (A.P.)
| | - Andrea Petraio
- Heart Transplant Unit, Department of Cardiac Surgery and Transplant, AORN dei Colli-Monaldi Hospital, 80131 Naples, Italy; (A.C.); (A.P.)
| | | | - Giuseppe Pacileo
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital Naples, 80131 Naples, Italy; (M.L.M.); (F.V.); (R.G.); (M.V.); (E.A.); (C.C.); (V.D.P.); (G.P.)
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