Impact of levosimendan on efficacy and renal function in acute heart failure according to renal function: A perspective, multi-center, real-world registry

Abstract

ObjectiveAcute heart failure (AHF) is associated with high mortality. Levosimendan, an inodilator, has proved to increase cardiac output and exert renoprotective effect in AHF. Our aim was to investigate the efficacy and renoprotective effects of levosimendan in patients with AHF and different renal function.MethodsThis is a prospective, observational, multi-center registry. Patients admitted with AHF between June 2020 and May 2022 and treated with levosimendan during the hospital stay were included. Baseline characteristics, laboratory tests, electrocardiogram (ECG), chest X-ray, echocardiography, and treatment were collected. A 5-point Likert scale was used to document patients' baseline dyspnea. The estimated glomerular filtration rate (eGFR) was calculated by means of the Modification of Diet in Renal Disease equation. After levosimendan infusion, patients underwent assessment of degree of dyspnea, and levels of brain-type natriuretic peptide (BNP) /N-terminal pro-BNP (NT-pro BNP), and eGFR repeatedly.ResultsAmong 789 AHF patients who received levosimendan treatment in this study, 33.0 % were female, mean age was 64.9 ± 16.8 years, and mean eGFR was 72.6 ± 32.5 ml/min/m2. The mean score of dyspnea was 3.0 ± 1.0 using 5-point Likert scale before levosimendan infusion. Dyspnea improved in 68.7% patients at 6h after infusion of levosimendan, and in 79.5% at 24 h. Lower eGFR was associated with lower efficacy rate after 6h infusion (71.7, 70.7, 65.2, and 66.0%, respectively) and after 24 h infusion (80.5, 81.4, 76.2, and 77.8%, respectively). The levels of BNP or NT-pro BNP were also decreased after levosimendan treatment, and in each eGFR category. Levels of eGFR increased from baseline (72.6 ± 32.5 ml/min/m2) to 12–24h (73.8 ± 33.5 ml/min/m2) and 24–72h (75.0 ± 33.4 ml/min/m2) after starting treatment (p < 0.001). However, the eGFR levels increased only in patients with eGFR lower than 90.0 ml/min/m2.ConclusionsIn AHF patients who received levosimendan, degree of dyspnea and levels of BNP or NT-pro BNP were significantly improved, especially in patients with higher eGFR levels. However, levosimendan infusion increase eGFR only in AHF patients with renal dysfunction.

Perioperative Application of Levosimendan Optimizes Postoperative Renal Function and Organ Perfusion in Patients with Severe Heart Failure

“…In comparison with levosimendan, dobutamine was found to be ineffective in patients receiving beta-blocker therapy [7]. Finally, a perspective, multi-center, real-world registry demonstrated that levosimendan infusion increased GFR only in acute heart failure patients with renal dysfunction [38].…”

Utilization of interpretable machine learning model to forecast the risk of major adverse kidney events in elderly patients in critical care

“…If a patient had documented CKD, it was defined as the lowest creatinine value during hospitalization [ 6 , 9 , 24 , 25 ]. Baseline glomerular filtration rates were calculated using the Modification of Diet in takes diseases equation estimation [ 26 ]. AKI was determined following the 2012 Kidney Disease: Improving Global Outcomes Clinical Practice Guidelines [ 27 ].…”

Consensus document on palliative care in cardiorenal patients

“… Levosimendan It was associated with a lower incidence of cardiorenal syndrome and better recovery of renal function at discharge, so Levosimendan appears to have some renoprotective effect and may be an effective and safe option in patients with advanced chronic kidney disease and heart failure. However, it is eliminated mainly by the kidneys, so the dose may need to be adjusted in these patients to avoid adverse effects and accumulation ( 100 , 101 ).…”