Sustained clinical stability and quality of life with intermittent levosimendan: a real-world experience of over 550 administrations
R Brandao, F Gerardo, L Cotrim, M Ribeiro, C Henriques, M Passos, A Oliveira Soares, I Fialho, D RoqueAbstract
Background
Levosimendan, a calcium-sensitizing inotrope, has demonstrated hemodynamic and symptomatic benefits in patients with advanced heart failure (AHF), potentially improving clinical stability and quality of life. This study aimed to evaluate the impact of intermittent levosimendan infusions (ILI) on functional class, biomarkers, and six-month clinical outcomes.
Methods
This retrospective, single-center study included 59 patients with AHF receiving ILI. Clinical and laboratory parameters were assessed at baseline and after six months of therapy. Variables compared included the number of heart failure (HF) hospitalizations, NYHA functional class, Seattle Heart Failure Model (SHFM) scores (1- and 5-year survival estimates), and NT-proBNP levels.
Results
The cohort included 59 patients, 77% men (n=46), with a mean age of 67 ± 12.9 years and a median BMI of 25 (IQR 21–27) kg/m². All patients had HFrEF, most commonly ischemic etiology (n=33, 55%), followed by idiopathic dilated cardiomyopathy (n=16, 27%). Baseline left ventricular ejection fraction was 24.6% (IQR 19.5–29.5), and NT-proBNP was 9,805 pg/mL (IQR 3,292–12,310). Before treatment, 97% of patients were in NYHA class III. Following initiation of levosimendan cycles, a significant reduction was observed in HF hospitalizations (p < 0.001) and an improvement in NYHA class (p < 0.001). Quality of life significantly improved, reflected by higher SHFM scores both at 1 year (81.7 ± 12.4 vs. 88.2 ± 9.2; p = 0.040) and 5 years (42.8 ± 24.9 vs. 57.5 ± 22.6; p = 0.018). NT-proBNP levels decreased markedly after six months (9,805 ± 10,709 pg/mL vs. 4,698 ± 5,789 pg/mL; p < 0.001), indicating improved decongestion and hemodynamic balance.
Conclusions
ILI were associated with a significant reduction in HF hospitalizations, improvement in functional class, and enhancement of quality-of-life scores, accompanied by a substantial decrease in NT-proBNP levels. These findings support the role of levosimendan as an effective therapeutic strategy for optimizing clinical status and prognosis in patients with advanced heart failure-either as palliative therapy for symptom control and quality-of-life improvement, or as a bridge to heart transplantation or LVAD implantation.