Outcomes in patients with acute heart failure treated with levosimendan: the impact of right ventricular function

Type of funding sources: None.

Despite recent advances, acute heart failure poses a therapeutic challenge due to its high morbidity and mortality both in the short and long term. Particularly, right ventricle failure is associated with worst outcomes.

Levosimendan has emerged as an option and its use is the object of ongoing investigation. Its mechanism of action relies both on troponin C calcium sensitization to improve contractility and ATP-dependent potassium channels activation of promoting vasodilation. These actions cause well-established effects on the function of the left ventricle and systemic circulation, but little is known of the role of the right ventricle.

We aimed to compare the outcomes of patients who received levosimendan regarding the presence of right ventricular failure.

Single-center retrospective study, including all hospitalized adult patients that received levosimendan for acute heart failure from 2011 to 2020. Cardiac surgery patients were excluded. Right heart failure was assessed by echocardiography and categorized as normal or mildly, moderately, or severely reduced. Acute kidney injury was defined as a creatinine increase of ≥ 50% or ≥ 0.3 mg/dl from its baseline.

A total of 52 patients were included for analysis. Their basal characteristics are described in table 1. All 3 patients (5.8%) that died during hospitalization showed right ventricular dysfunction. Acute kidney injury was more common in patients with right ventricular dysfunction (36.4% versus 10.5%, p = 0.04), as can be seen in figure 1. There were 9 cases of hypotension (17.3%), with no significant differences between groups.

In patients, hospitalized with acute heart failure who received levosimendan, right ventricle failure with associated with worst outcomes, particularly with acute kidney injury.