Cardiac cachexia as a key determinant of clinical stability in advanced heart failure patients treated with intermittent levosimendan
R Brandao, F Gerardo, L Cotrim, M Ribeiro, C Henriques, M Passos, A Oliveira Soares, I Fialho, D RoqueAbstract
Introduction
Levosimendan is a calcium-sensitizing inotrope used in patients with advanced heart failure (HF) and can be administered in intermittent regimens for symptomatic control. However, predictors of clinical stability after the discontinuation of levosimendan cycles remain poorly defined.
Objectives
Identify predictors of clinical stability in patients with advanced HF treated with intermittent levosimendan.
Methods
Retrospective, single-center study including 59 patients with advanced HF undergoing intermittent levosimendan infusions (ILI). Clinical stability was defined as a composite outcome comprising the absence of HF-related hospitalizations and the absence of the need to restart ILI at 6 months. Potential clinical, laboratory, and therapeutic predictors were analyzed through multivariable logistic regression.
Results
Among 59 patients (73% male), all had HFrEF, with ischemic etiology being the most common (55%, n=33). In multivariable analysis, only body mass index at baseline was independently associated with clinical stability (OR = 1.35; p = 0.017). Neither sex (OR:0.88; p=0.90), ischemic etiology (OR: 2.32; p= 0.27), baseline NT-proBNP levels (OR: 1.00; p=0.013), cardiac resynchronization (OR: 0.50; p= 0.53) or presence of ICD (OR: 0.25; p= 0.14), diuretic (OR: 1.00; p= 0.65) or mineralocorticoid antagonist use (OR: 1.04; p=0.17) reached statistical significance.
Conclusion
In patients with advanced HF treated with intermittent levosimendan, clinical stability at 6 months was predicted by higher BMI. These findings reinforce the negative prognostic impact of cachexia and malnutrition in this population, an aspect that is often ignored specially regarding clinical stability and quality of life.