Mortality predictors and prognostic implications of intermittent levosimendan therapy in advanced heart failure
R Brandao, F Gerardo, L Cotrim, M Ribeiro, C Henriques, M Passos, A Oliveira Soares, I Fialho, D RoqueAbstract
Introduction
Levosimendan, a calcium-sensitizing inotrope, has emerged as a therapeutic option for patients with advanced heart failure (AdHF) through its intermittent administration, either on a monthly or biweekly schedule. However, predictors of all-cause mortality in this population remain insufficiently defined, particularly among patients receiving optimized guideline-directed medical therapy.
Objectives
Identify predictors of all-cause mortality in patients with advanced HF undergoing regular intermittent levosimendan infusions (ILI).
Methods
Single-center, retrospective study including 59 patients with advanced HF treated with ILI. Potential clinical, echocardiographic, and laboratory predictors of mortality were analyzed, including baseline and 6-month NT-proBNP levels, furosemide dose, left ventricular ejection fraction (LVEF), age, sex, and the presence of cardiac resynchronization therapy (CRT) or implantable cardioverter-defibrillator (ICD) devices. Multivariate logistic regression was performed to identify independent predictors.
Results
Among 59 patients (73% male), all had HFrEF, with ischemic etiology being the most common (55%, n=33), followed by idiopathic dilated cardiomyopathy (n=16, 27%). Median baseline LVEF was 24.6% (IQR 19.5–29.5), and median NT-proBNP was 9,805 pg/mL (IQR 3,292–12,310). Multivariate analysis identified two independent predictors of all-cause mortality: baseline furosemide dose (OR = 1.1; p = 0.047) and 6-month NT-proBNP levels (OR: 1.1; p=0,043). Older age (OR:1.25; p=0.129) showed a non-significant trend toward higher mortality.
Conclusions
In patients with AdHF receiving ILI, all-cause mortality was independently predicted by higher baseline furosemide doses and persistently elevated NT-proBNP at 6 months. These findings highlight the negative prognostic impact of congestion in AdHF patients, showing that refractory congestion is an important poor prognosis indicator and should prompt consideration for advanced therapies referral.