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Hemodynamic and clinical effects of ARNI therapy in patients with advanced heart failure undergoing repeated Levosimendan infusions

Session Poster Session 2

Speaker Alessandro Verde

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure – Treatment
  • Session type : Poster Session

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 , M Varrenti1 , A Verde1 , C Santolamazza1 , MG Cipriani1 , A Garascia1 , E Ammirati1 , E Perna1 , M Frigerio1 , M Cottini2 , 1ASST Great Metropolitan Hospital Niguarda, Heart Failure and Transplant Unit, Niguarda Cardio Center - Milan - Italy , 2ASST Great Metropolitan Hospital Niguarda, Cardiac Surgery Unit, Niguarda Cardio Center - Milan - Italy ,


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.

T0 T1 T2 p 0vs1 p 1vs2 p 0vs2
LVEF (%) 23 20 24 0,3 0,3 0,4
LVEDV (ml) 273 315 257 0,4 0,5 0,4
TAPSE (mm) 14 21 20 0,2 0,05 0,04
NTproBNP (ng/L) 3360 1584 1271 0,02 0,5 0,02
RAP (mmHg) 7 4 4 0,3 0,2 0,009
SPAP (mmHg) 48 33 26 0,3 0,2 0,01
DPAP (mmHg) 20 17 10 0,5 0,03 0,001
MPAP (mmHg) 32 22 16 0,02 0,05 0,3
WP (mmHg) 21 15 11 0,3 0,5 0,001
CI (L/min/mq) 1,8 1,8 2 0,5 0,4 0,004

VPR-I (WU/mq)

5,3 3,8 2,5 0,6 0,03 0,08
CREA (mg/dL) 1,1 1,4 1,1 0,8 0,03 0,1
BUN (mg/dL) 59 62 39 0,2 0,04 0,7
p:p-value; LVEF:left ventricular ejection fraction; LVEDV:left ventricular end-diastolic volume; TAPSE:tricuspid annular plane systolic excursion ; NT-pro-BNP:terminal fragment of brain natriuretic peptide; RAP:right atrial pressure; SPAP:systolic pulmonary arterial pressure; DPAP:diastolic pulmonary arterial pressure; MPAP:mean pulmonary arterial pressure; WP:wedge pressure; CI:cardiac index; VPR-I:indexed vascular pulmonary resistances; CREA:creatinine; BUN: blood urea nitrogen

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