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Sacubitril-valsartan treatment furtherly improves response to intermittent parenteral levosimendan in ambulatory patients with advanced heart failure with reduced ejection fraction

Session Poster Session 3

Speaker Benjamin Munoz Calvo

Event : Heart Failure 2019

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

Authors : B Munoz Calvo (Alcala de Henares,ES), C Ganan-Gomez (Alcala de Henares,ES), A Quiles-Recuenco (Alcala de Henares,ES), B Calvo-Llorente (Alcala de Henares,ES), I Mendo-Pedrajas (Alcala de Henares,ES), J Navarro-Lopez (Alcala de Henares,ES), F Roman-Garcia (Alcala de Henares,ES)

Authors:
B Munoz Calvo1 , C Ganan-Gomez1 , A Quiles-Recuenco1 , B Calvo-Llorente1 , I Mendo-Pedrajas1 , J Navarro-Lopez1 , F Roman-Garcia1 , 1Hospital Universitario Príncipe de Asturias - Alcala de Henares - Spain ,

Citation:

BACKGROUND: : Intravenous intermittent administration of levosimendan (IALEVO) to ambulatory patients with advanced chronic heart failure (ACHF) with severely reduced  (< 35%)  ejection fraction (EF) has been shown  in several randomized trials (LAICA, LION-HEART, Levo-Rep) to improve their clinical status and to reduce NT-proBNP plasma levels and rehospitalizations. However, recruitment of patients in these trials were conducted in the pre-ARNI era, so the impact of simultaneous treatment with sacubitril-valsartan (SAV) on IALEVO strategy is unknown.
AIMS: To assess whether SAV treatment may affect the results of IALEVO in patients with ACHF.
METHODS AND RESULTS: we conducted an observational, non-randomized study on 36 patients with ACHF of a similar profile with SAV treatment for at least the previous 12 months.  Patients were randomly assigned at a 1:1 ratio to IALEVO or non-intervention groups; those receiving IALEVO were given a 6-hour intravenous infusion (0.2 µg/kg/min without bolus) every 2 weeks for 12 weeks. The primary endpoint was the effect on serum concentrations of NT-proBNP throughout the treatment period. Secondary endpoints included evaluation of 18-months rehospitalizations due to HF decompensation and score at the Kansas City Cardiomyopathy test. The area under the curve of the levels of NT-proBNP for patients who received IALEVO was significantly lower than for the non-intervened group (259 × 103 [95% Confidence Interval (CI) 189 × 103-395 × 103] vs. 328 × 103 [240 × 103-517 × 103], p = 0.004). In comparison with non-intervened group, the patients on IALEVO experienced a reduction in the rate of heart failure hospitalisation (hazard ratio 0.20; 95% CI 0.10–0.49; P = 0.001). Patients on IALEVO were less likely to experience a significant reduction in KCC score (P = 0.04). Adverse effects were similar in both groups. 
Conclusions:  In this small non-randomized, non controlled study, IALEVO to ambulatory patients with ACHF with EF < 35% already treated with SAV reduced plasma concentrations of NT-proBNP and hospitalization for HF decompensation. As with other patients in the pre-ARNI era, IALEVO seems to furtherly improve clinical and functional benefits provided by SAV in ACHF.

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