Levosimendan Administration May Provide More Benefit for Survival in Patients with Non-Ischemic Cardiomyopathy Experiencing Acute Decompensated Heart Failure

Wei-Chieh Lee; Po-Jui Wu; Hsiu-Yu Fang; Yen-Nan Fang; Huang-Chung Chen; Meng-Shen Tong; Pei-Hsun Sung; Chieh-Ho Lee; Wen-Jung Chung

doi:10.3390/jcm11143997

Levosimendan Administration May Provide More Benefit for Survival in Patients with Non-Ischemic Cardiomyopathy Experiencing Acute Decompensated Heart Failure

J Clin Med. 2022 Jul 10;11(14):3997. doi: 10.3390/jcm11143997.

Authors

Wei-Chieh Lee^{1

2}, Po-Jui Wu³, Hsiu-Yu Fang³, Yen-Nan Fang³, Huang-Chung Chen³, Meng-Shen Tong³, Pei-Hsun Sung³, Chieh-Ho Lee³, Wen-Jung Chung³

Affiliations

¹ Division of Cardiovascular Medicine, Chi-Mei Medical Center, Tainan 71004, Taiwan.
² Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan.
³ Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.

Abstract

Background: Acute decompensated heart failure (ADHF) is a life-threatening condition with a high mortality rate. Levosimendan is an effective inotropic agent used to maintain cardiac output and a long-lasting effect. However, only few studies have compared the clinical outcomes, after levosimendan therapy, among etiologies of ADHF.

Methods: Between July 2014 and December 2019, 184 patients received levosimendan therapy for ADHF at our hospital. A total of 143 patients had ischemic cardiomyopathy (ICM), and 41 patients had non-ICM (NICM). Data on comorbidities, echocardiographic findings, laboratory findings, use of mechanical devices, consumption of other inotropic or vasopressor agents, frequency of HF hospitalization, cardiovascular (CV) mortality, and all-cause mortality were compared between the ICM and NICM groups.

Results: Patients with ICM were older with higher prevalence of diabetes mellitus when compared to patients with NICM. Patients with NICM had a poorer left ventricular ejection fraction (LVEF) and higher left ventricular end-systolic volume when compared to patients with ICM. At the 30 day follow-up period, a lower CV mortality (ICM vs. NICM: 20.9% vs. 5.1%; log-rank p = 0.033) and lower all-cause mortality (ICM vs. NICM: 28.7% vs. 9.8%; log-rank p = 0.018) was observed in the NICM patients. A significantly lower all-cause mortality was noted at 180 day (ICM vs. NICM: 39.2% vs. 22.0%; log-rank p = 0.043) and 1 year (ICM vs. NICM: 41.3% vs. 24.4%; log-rank p = 0.046) follow up in the NICM subgroup. NICM (hazard ratio (HR): 0.303, 95% confidence interval (CI): 0.108-0.845; p = 0.023) and ECMO use (HR: 2.550, 95% CI: 1.385-4.693; p = 0.003) were significant predictors of 30 day all-cause mortality.

Conclusions: In our study on levosimendan use for ADHF patients, better clinical outcomes were noted in the NICM population when compared to the ICM population. In the patients with cardiogenic shock or ventilator use, significantly lower incidence of 30 day mortality presented in the NICM population when compared with the ICM population.

Keywords: acute decompensated heart failure; ischemic cardiomyopathy; levosimendan; mortality; non-ischemic cardiomyopathy.

Grants and funding

This research received no external funding.