It is easy to see, but it is better to foresee: a case report on the favourable alliance between CardioMEMS and levosimendan

Abstract

Background In the past years, different devices have been investigated to help in identifying early decompensation events in patients with heart failure (HF) and reduced ejection fraction (EF), reducing hospital admissions. In this report, we present the first patient experience with levosimendan infusion led by CardioMEMS. Case summary A 68-year-old man with HF and reduced EF with more than 20 hospitalizations for exacerbation of HF was enrolled in our HF Clinic from October 2017. Echocardiogram showed a dilated left ventricle with severely reduced EF (29%) and increased pulmonary artery systolic pressure (40 mmHg). From October 2017 to May 2019, the patient went through numerous hospitalizations, despite optimal medical therapy; subsequently, was adopted a strategy of levosimendan infusions guided by CardioMEMS. Levosimendan infusions improved haemodynamic and pressure profiles. The patient was monitored daily by CardioMEMS, and from June to December 2019, he had only two hospitalizations scheduled for levosimendan infusion and none for HF exacerbation. Discussion Our case supports the combination of CardioMEMS and levosimendan for the optimal management of patients with advanced HF. These results further strengthen the development of a randomized clinical trial to demonstrate the clinical usefulness of this device in combination with the levosimendan infusion programme in advanced HF patients.

Predictors of sacubitril/valsartan high dose tolerability in a real world population with HFrEF

“…However, in patients with significant bi‐ventricular dysfunction, uncertainties about the fine management of this drug need to be elucidated by assessing the exact mechanisms linked to an improvement of RV function. 35 , 36 , 37 …”

A Multistep Approach to Deal With Advanced Heart Failure: A Case Report on the Positive Effect of Cardiac Contractility Modulation Therapy on Pulmonary Pressure Measured by CardioMEMS

“…On the one hand, the CardioMEMS (Abbott Medical, Inc., Abbott Park, Illinois, USA) is an implantable device positioned in the pulmonary artery and is able to detect higher cardiac filling pressures, an objective measure of “hemodynamic congestion,” estimated to rise more than 2 weeks before the onset of symptomatic congestion ( 6 , 7 ); this device is applicable in patients with chronic HF in functional New York Heart Association (NYHA) Class III with at least one admission for HF in the past year (class of recommendation IIb according to HF ESC Guideline 2021) ( 2 ). On the other hand, cardiac contractility modulation (CCM) therapy has emerged as a hopeful device treatment in patients with HF not indicated for cardiac resynchronization therapy ( 5 ).…”

Use of Cardiac Contractility Modulation as Bridge to Transplant in an Obese Patient With Advanced Heart Failure: A Case Report

“…Another strategy used in patients with advanced heart failure is the periodic infusion of levosimendan ( 19 ), which can lead to an improvement in the hemodynamic profile ( 20 ) and quality of life as well as reduction of acutely decompensated heart failure episodes in patients with advanced HFrEF ( 21 ). Pulsed levosimendan infusion can be performed at fixed intervals or by assessing changes in hemodynamic parameters ( 22 ), leading to a clear clinical benefit in both cases. However, little data are available on the efficacy of this therapeutic approach in obese patients (body weight > 120 kg); therefor this therapeutic option has not been performed.…”