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Hemodynamic and clinical effects of ARNI therapy in patients with advanced heart failure undergoing repeated Levosimendan infusions
Authors : G Masciocco (Milan,IT), M Varrenti (Milan,IT), A Verde (Milan,IT), C Santolamazza (Milan,IT), MG Cipriani (Milan,IT), A Garascia (Milan,IT), E Ammirati (Milan,IT), E Perna (Milan,IT), M Frigerio (Milan,IT), M Cottini (Milan,IT)
G Masciocco1
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M Varrenti1
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A Verde1
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C Santolamazza1
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MG Cipriani1
,
A Garascia1
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E Ammirati1
,
E Perna1
,
M Frigerio1
,
M Cottini2
,
1ASST Great Metropolitan Hospital Niguarda, Heart Failure and Transplant Unit, Niguarda Cardio Center - Milan - Italy
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2ASST Great Metropolitan Hospital Niguarda, Cardiac Surgery Unit, Niguarda Cardio Center - Milan - Italy
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Topic(s): Chronic Heart Failure – Treatment
Background: repetead Levosimendan infusions (rp-Levo) improve hemodynamics and symptoms in patients (pts) with advanced heart failure (aHF). Sacubitril/Valsartan, which benefit are known in pts with moderate HF, could be attempted. Methods: from Jan 2016 to Dec 2018, 30 aHF outpatients had rp-Levo 12,5 mg (0.05-0.1 mcg/Kg/min) every 3-4 weeks awaiting heart transplantation (HTx). Seven pts (5 M, 2 F, age 53+/-10y, 3 ischemic etiology) could be weaned from rp-Levo after starting ARNI. Data at baseline (T0), at rp-Levo withdrawal (T1, median time on rp-Levo 11mo), and after 6 months (T2, median time on ARNI 8mo) were compared. Results: Sacubitril/Valsartan median dosage was 132 + 139 mg. Changes over time are presented in the Table. An improvement in hemodynamics and RV function was observed on rp-Levo, reaching statistical significance on ARNI. Inferences: ARNI therapy could be attempted in stable pts with aHF, even if on rp-Levo, and may give a significant improvement of the hemodynamic profile despite end-stage LV dysfunction. The role of ARNI in aHF pts, including HTx candidates, deserves to be explored.
