Levosimendan Administration May Provide More Benefit for Survival in Patients with Non-Ischemic Cardiomyopathy Experiencing Acute Decompensated Heart Failure

Abstract

Background: Acute decompensated heart failure (ADHF) is a life-threatening condition with a high mortality rate. Levosimendan is an effective inotropic agent used to maintain cardiac output and a long-lasting effect. However, only few studies have compared the clinical outcomes, after levosimendan therapy, among etiologies of ADHF. Methods: Between July 2014 and December 2019, 184 patients received levosimendan therapy for ADHF at our hospital. A total of 143 patients had ischemic cardiomyopathy (ICM), and 41 patients had non-ICM (NICM). Data on comorbidities, echocardiographic findings, laboratory findings, use of mechanical devices, consumption of other inotropic or vasopressor agents, frequency of HF hospitalization, cardiovascular (CV) mortality, and all-cause mortality were compared between the ICM and NICM groups. Results: Patients with ICM were older with higher prevalence of diabetes mellitus when compared to patients with NICM. Patients with NICM had a poorer left ventricular ejection fraction (LVEF) and higher left ventricular end-systolic volume when compared to patients with ICM. At the 30 day follow-up period, a lower CV mortality (ICM vs. NICM: 20.9% vs. 5.1%; log-rank p = 0.033) and lower all-cause mortality (ICM vs. NICM: 28.7% vs. 9.8%; log-rank p = 0.018) was observed in the NICM patients. A significantly lower all-cause mortality was noted at 180 day (ICM vs. NICM: 39.2% vs. 22.0%; log-rank p = 0.043) and 1 year (ICM vs. NICM: 41.3% vs. 24.4%; log-rank p = 0.046) follow up in the NICM subgroup. NICM (hazard ratio (HR): 0.303, 95% confidence interval (CI): 0.108–0.845; p = 0.023) and ECMO use (HR: 2.550, 95% CI: 1.385–4.693; p = 0.003) were significant predictors of 30 day all-cause mortality. Conclusions: In our study on levosimendan use for ADHF patients, better clinical outcomes were noted in the NICM population when compared to the ICM population. In the patients with cardiogenic shock or ventilator use, significantly lower incidence of 30 day mortality presented in the NICM population when compared with the ICM population.

Therapeutic Development of Levosimendan in Acute and Advanced Heart Failure: A Systematic Review

“…Patients with severe symptoms, frequent de-compensation, and clearly noticeable significant cardiac dysfunction are referred to as having "advanced HF (AdHF)" [1], whereas acute HF (AHF) is characterized by the sudden development of decompensated symptoms and/or HF indicators and is a potentially fatal condition with a short-term mortality rate of about 30% [1][2][3]. Breathing difficulties, orthopnea, leg edema, and weariness are typical symptoms of HF [4]. Because of frequent hospitalizations owing to acute decompensation or aggravation, HF reduces the quality of life by increasing morbidity and mortality.…”

“…Unfortunately, there is no treatment plan for acutely decompensated HF that is effective in all cases with various etiologies. For example, in patients with known HF, the use of beta agonists may increase all-cause mortality, HF hospitalization, and the use of vasodilators, whereas the use of vasopressors increases vasoconstriction, increasing systemic vascular resistance, and deteriorating acute decompensated HF [4]. Due to its unique mode of action, levosimendan (LS), a calcium sensitizer and potassium channel opener, has recently drawn interest as a potential replacement for inotropy that may be safer than the conventional classes of cardio-mobilizing medications [8].…”