Echocardiographic and biomarker response to levosimendan cycles in advanced heart failure
R Fernandes Da Silva, R Louro, P Correia, R Viana, M Paralta De Figueiredo, A Raquel Clerigo, A Batista, P Ameixa, D Veladas, S Alexandrino, T Grenho, K Congo, B Picarra, R Caldeira Da Rocha, M TrincaAbstract
Background
Intermittent levosimendan is increasingly used in patients with advanced heart failure to improve symptoms and reduce recurrent decompensations. However, real-world data regarding the biological and echocardiographic response to repeated cycles and their prognostic significance remain limited.
Purpose
To evaluate echocardiographic and biomarker response to repeated levosimendan cycles in patients with advanced heart failure and to explore their association with adverse heart-failure–related outcomes.
Methods
We performed a study including patients with advanced heart failure treated with levosimendan. Changes in echocardiographic parameters and laboratory biomarkers between baseline and follow-up were analyzed. A composite outcome of heart failure hospitalization and all-cause mortality was assessed. Non-parametric statistical methods were used for group comparisons.
Results
Thirty-three patients were included (mean age 69.7 ± 14.6 years; 45.5% ischemic cardiomyopathy). The median number of levosimendan cycles was 11 (range 1–44), with a median follow-up of 279 days (IQR 148–532). Left ventricular systolic function showed numerical improvement, with LVEF increasing by 3.8%. Patients free from adverse events demonstrated greater LVEF improvement than those experiencing the composite outcome (median +4.0% vs +1.0%, p = 0.05), along with a parallel trend toward improvement in left ventricular filling pressures (ΔE/e′, p = 0.05). NT-proBNP showed a marked numerical reduction (mean −2179 pg/mL), with a significantly greater decrease in patients without adverse events (median −1372 vs +1440 pg/mL, p = 0.025). Transferrin saturation increased significantly (+6.8%, p = 0.05), whereas ferritin, hemoglobin and CA-125 remained stable, suggesting improved functional iron availability. No significant differences were observed in TAPSE, hemoglobin, transferrin saturation or number of levosimendan cycles between patients with and without adverse outcomes.
Conclusions
In this cohort of patients with advanced heart failure receiving levosimendan cycles on top of optimized medical therapy, treatment was associated with numerical improvement in ventricular function and biologically meaningful reductions in NT-proBNP. Reduction in NT-proBNP was associated with a lower risk of heart-failure–related adverse outcomes, supporting the potential value of biomarker-guided assessment to identify patients more likely to derive prognostic benefit from this therapy.