Abstract 13474: The Efficacy of Istaroxime for Patients With Acute Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Introduction: Acute heart failure (AHF) exacerbation is the leading cause of morbidity and mortality associated with HF. The current AHF management strategies are inotropic and vasoactive agents. Despite the transient improvement in hemodynamic status with these agents, they have not shown survival benefits. Istaroxime is a novel IV inotropic agent with a dual mechanism, increasing both cardiomyocyte contractility as well as relaxation.

Methods: We conducted a systematic review and meta-analysis synthesizing randomized controlled trials (RCTs), which were retrieved by systematically searching: PubMed, Web of Science, SCOPUS, and Cochrane through April 24th, 2023. We used the fixed-effect or random-effects model, according to heterogeneity, to pool dichotomous data using risk ratio (RR) and continuous data using mean difference (MD), with a 95% confidence interval (CI).

Results: We included three RCTs with a total of 300 patients. Istaroxime was significantly associated with increased LV ejection fraction (MD: 1.06, CI [0.29, 1.82], P = 0.007), stroke volume index (MD: 3.04, CI [2.41, 3.67], P = 0.00001), and cardiac index (L/min/m2) (MD: 0.18, CI [0.11, 0.25], P = 0.00001). Also, istaroxime was significantly associated with decreased E/A ratio (MD: -0.39, CI [-0.58, -0.19], P = 0.0001) and pulmonary artery systolic pressure (MD: -2.30, CI [-3.20, -1.40], P = 0.00001). Istaroxime was significantly associated with increased systolic blood pressure (MD: 5.32, CI [2.28, 8.37], P = 0.0006) and decreased heart rate (MD: -3.05, CI [-5.27, -0.82], P = 0.007).

Conclusions: Istaroxime improved blood pressure and some echocardiographic parameters, forming a promising strategy for AHF management. However, the current is limited to a small number of RCTs, warranting further large-scale phase III trials before clinical endorsement.