Repetitive ambulatory levosimendan as a bridge to heart transplantation

Rev Esp Cardiol (Engl Ed). 2024 Apr;77(4):290-301. doi: 10.1016/j.rec.2023.07.002. Epub 2023 Jul 27.
[Article in English, Spanish]

Abstract

Introduction and objectives: Repetitive ambulatory doses of levosimendan are an option as a bridge to heart transplantation (HT), but evidence regarding the safety and efficacy of this treatment is scarce. The objective of the LEVO-T Registry is to describe the profile of patients on the HT list receiving levosimendan, prescription patterns, and clinical outcomes compared with patients not on levosimendan.

Methods: We retrospectively reviewed all patients listed for elective HT from 2015 to 2020 from 14 centers in Spain.

Results: A total of 1015 consecutive patients were included, of whom 238 patients (23.4%) received levosimendan. Patients treated with levosimendan had more heart failure (HF) admissions in the previous year and a worse clinical profile. The most frequent prescription pattern were fixed doses triggered by the patients' clinical needs. Nonfatal ventricular arrhythmias occurred in 2 patients (0.8%). No differences in HF hospitalizations were found between patients who started levosimendan in the first 30 days after listing and those who did not (33.6% vs 34.5%; P=.848). Among those who did not, 102 patients (32.9%) crossed over to levosimendan after an HF admission. These patients had a rate of 0.57 HF admissions per month before starting levosimendan and 0.21 afterwards. Propensity score matching analysis showed no differences in survival at 1 year after listing between patients receiving levosimendan and those who did not (HR, 1.03; 95%CI, 0.36-2.97; P=.958) or in survival after HT (HR, 0.97; 95%CI, 0.60-1.56; P=.958).

Conclusions: Repetitive levosimendan in an ambulatory setting as a bridge to heart transplantation is commonly used, is safe, and may reduce HF hospitalizations.

Keywords: Cardiotonic agents; Cardiotónicos; Heart failure; Heart transplantation; Insuficiencia cardiaca; Simendan; Simendán; Trasplante de corazón.

MeSH terms

  • Cardiotonic Agents / therapeutic use
  • Heart Failure* / drug therapy
  • Heart Failure* / surgery
  • Heart Transplantation*
  • Humans
  • Hydrazones / therapeutic use
  • Pyridazines* / therapeutic use
  • Retrospective Studies
  • Simendan / therapeutic use
  • Treatment Outcome

Substances

  • Simendan
  • Cardiotonic Agents
  • Hydrazones
  • Pyridazines