scholarly journals Intermittent therapy with levosimendan in patients with advanced heart failure

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Blaschke ◽  
A Kiwi ◽  
C Hagl ◽  
M Weis
Keyword(s):  
Heart Failure ◽  
Time Course ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Advanced Heart Failure ◽  
Intermittent Therapy ◽  
Single Center ◽  
Open Label ◽  
Bridge To Transplant ◽  
Funding Sources ◽  
Calcium Sensitizer

Abstract Introduction Therapeutic options for patients with advanced heart failure on the high-urgent (HU) heart transplant (HTx) waiting list are limited. In view of the limited data on the usefulness of classic inotropes, the calcium sensitizer levosimendan (Lev) may be a possible alternative for patients in need of a repetitive therapy with an inotropic agent as a bridge to HTx. Method In a single-center open-label study we retrospectively analyzed data from 34 HU-listed patients (from a total collective of 95 HU patients) who repetitively received Lev (12.5 mg; 0,05–0.1 μg/kg/min over 24–48h) in 2–8 weeks intervals due to cardiac instability and/or progressive second organ dysfunction. Potential side effects as well as changes of kidney, liver and heart functional parameters were evaluated (0–6 days before, 4–8 days and 14–20 days after Lev infusion). Patient collective: age 51±10 years, 6 women, 28 men; NYHA stage III-IV. 11 Patients with ischemic cardiomyopathy (32%), 19 patients with dilated cardiomyopathy (56%), 4 patients with arrhythmogenic right ventricular cardiomyopathy (12%). Results The waiting time for HTx was up to 12 months (6±5 months). There were no adverse, serious events (resuscitation, defibrillation for ventricular tachycardia (VT), intubation and ventilation, renal replacement therapy) up to 7 days after Lev infusion. Transient cardiac arrhythmias (ventricular bursts or non-sustained VTs) occurred in 11 patients (32%) with spontaneous termination and no need of urgent anti-arrhythmic therapy. The values for sodium, potassium, Hb and CRP did not change significantly after Lev. In contrast, there was a significant reduction in creatinine after 4–8 days (initially 1.43±0.4 mg/dl; after 4–8 days 1.28±0.3; p<0.0005) with an increase again after 14–20 days (1.43±0.3 mg/dl). The bilirubin value was significantly reduced after 4–8 days (initially 1.63±0.7 mg/dl; after 4–8 days 1.30±0.5; p<0.0005) with only partial (non-significant) increases again over the course (1.34±0.5 mg/dl). The BNP value was significantly reduced 4–8 days after administration of Lev (initially 1565±1136 ng/l; after 4–8 days 1103±895; p<0.0001) and increased again in the longer time course (1462±1001 ng/l; p<0.001 versus 4–8 days). 28 patients were successfully transplanted (82%). 6 patients remained without HTx (18%), of which 1 patient (3%) with clinical improvement could be discharged. 2 patients (6%) received an LVAD and 3 patients (9%) died during the waiting period. Conclusion Intermittent therapy with Lev as “a bridge to transplant” is safe and effective concerning deterioration of heart failure and prevention of progressive kidney/hepatic dysfunction. However, a prospective randomized multi-center trial is necessary to underscore the encouraging data of this observational, single center study. FUNDunding Acknowledgement Type of funding sources: None.

Abstract 225: Frequency and Assessment of Poor Global Outcome in Patients with Left Ventricular Assist Devices

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Timothy J Fendler ◽  
Michael E Nassif ◽  
Kevin F Kennedy ◽  
John A Spertus ◽  
Shane J LaRue ◽  
...  
Keyword(s):  
Heart Failure ◽  
Nyha Class ◽  
Left Ventricular ◽  
Advanced Heart Failure ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Bridge To Transplant ◽  
Patient Reported ◽  
Left Ventricular Assist

Background: Left ventricular assist device (LVAD) therapy can improve survival and quality of life in advanced heart failure (HF), but some patients may still do poorly after LVAD. Understanding the likelihood of experiencing poorer outcomes after LVAD can better inform patients and calibrate their expectations. Methods: We analyzed patients receiving LVAD therapy from January 2012 to October 2013 at a single, high-volume, high-acuity center. We defined a poor global outcome at 1 year after LVAD as the occurrence of death, disabling stroke (precluding transplant), poor patient-reported health status (most recent KCCQ at 3, 6, or 12 months < 45, corresponding to NYHA class IV), or recurrent HF (≥2 HF readmissions post-implant). We compared characteristics of those with and without poor global outcome. Results: Among 164 LVAD recipients who had 1-year outcomes data, mean age was 56, 76.7% were white, 20.9% were female, and 85.9% were INTERMACS Profile 1 or 2 (cardiogenic shock or declining despite inotropes). Poor global outcome occurred in 58 (35.4%) patients at 1 year, of whom 37 (63.8%) died, 17 (29.3%) had a most recent KCCQ score < 45, 3 (5.2%) had ≥2 HF readmissions, and 1 (1.7%) had a disabling stroke (Figure). Eight of the patients who died also experienced one of the three other poor outcomes prior to death. Patients who experienced a poor global outcome were more likely to be designated for destination therapy (46.4% vs. 23.6%, p=0.01) than bridge to transplant, have longer index admissions (median [IQR]: 39 [24, 57] days vs. 25 [18, 35] days, p=0.003), and have major GI bleeding (44.2% vs. 27.7%, p=0.056), and were less likely to undergo LVAD exchange (0% vs. 12.3%, p=0.004). Conclusion: In this large, single-center study assessing global outcome after LVAD implantation, we found that about a third of all patients had experienced a poor global outcome at 1 year. While LVAD therapy remains life-saving and the standard of care for many patients with advanced heart failure, these findings could help guide discussions with eligible patients and families. Future work should compare patients’ pre-LVAD expectations with likely outcomes and create risk models to estimate the probability of poorer outcomes for individual patients using pre-procedural factors.

Bariatric Surgery Provides a “Bridge to Transplant” for Morbidly Obese Patients with Advanced Heart Failure and May Obviate the Need for Transplantation

2015 ◽  
Vol 26 (3) ◽  
pp. 486-493 ◽  
Author(s):  
Choon-Pin Lim ◽  
Oliver M. Fisher ◽  
Dan Falkenback ◽  
Damien Boyd ◽  
Christopher S. Hayward ◽  
...  
Keyword(s):  
Heart Failure ◽  
Bariatric Surgery ◽  
Advanced Heart Failure ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Bridge To Transplant

scholarly journals Anaerobic Bacteremias in Left Ventricular Assist Devices and Advanced Heart Failure

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
David R. Murillo-Garcia ◽  
Julian Galindo ◽  
Natalia Pinto ◽  
Gabriel Motoa ◽  
Esther Benamu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Survival Rates ◽  
Left Ventricular ◽  
Advanced Heart Failure ◽  
Ventricular Assist Devices ◽  
First Year ◽  
Left Ventricular Assist Devices ◽  
Term Outcome ◽  
Odontogenic Infections ◽  
Bridge To Transplant

Left ventricular assisted devices (LVADs) have revolutionized the treatment of advanced heart failure, providing meaningful increases in survival, functional capacity, and quality of life. There are two categories of LVADs patients: (1) bridge-to-transplant and (2) destination therapy. Advanced heart failure and destination LVADs often carry a poor prognosis. The overall 1-year mortality rate remains as high as 30%. LVAD-specific infections, LVAD-related infections, and non-LVAD-related infections represent important emerging clinical problems in this setting. With an incidence ranging from 30 to 50%, these lead to high rates of hospitalization, morbidity, and mortality. Bacteremias caused by anaerobic pathogens in patients with LVAD are underreported. Herein, we describe the microbiological findings, treatment, and clinical outcome of four patients with LVADs and advanced heart failure with anaerobic bacteremias. Fusobacterium species was the most frequent etiological agent. Most patients had a relatively favorable short-term outcome with survival rates of 100% at 30 days and of 50% at 90 days. However, due to other multiple long-term complications, overall mortality remains at 50% during the first year and increases to 75% beyond the first year. Anaerobic bacteremia sources included the oral cavity from odontogenic infections and aspiration pneumonia. Anaerobic bacteremia constitutes an unfavorable mortality prognostic factor in patients with destination LVADs. We recommend implementing preventive strategies with a comprehensive dental care evaluation in patients with LVADs and advanced heart failure.

A Single Center Experience in Racial Differences at the Time of Referral To Advanced Heart Failure Clinic

2014 ◽  
Vol 20 (8) ◽  
pp. S43-S44
Author(s):  
Vivak M. Master ◽  
Mohamad Mohamad Alahmad ◽  
Abbas Bitar ◽  
Bassel Alkhalil ◽  
Kathy Dailey ◽  
...  
Keyword(s):  
Heart Failure ◽  
Racial Differences ◽  
Advanced Heart Failure ◽  
Single Center ◽  
Single Center Experience ◽  
Heart Failure Clinic

scholarly journals Door-to-Furosemide time effects on in-hospital mortality and length of stay in acute heart failure patients

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
K.V Viriyanukulvong ◽  
A.H Han-Gla ◽  
J.P Phannajit ◽  
A.A Ariyachaipanich
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
Acute Heart Failure ◽  
Early Treatment ◽  
Hospital Death ◽  
Single Center ◽  
Hospital Outcomes ◽  
Baseline Serum ◽  
Funding Sources ◽  
Patient Arrival

Abstract Background Acute heart failure (AHF) is a common cause of hospitalization and mortality. Time-to-therapy concept may help improve in-hospital outcomes. Objective To evaluate In-hospital outcomes after receiving early versus delayed furosemide injection among AHF patients. Method Retrospective single-center cohort study included patients who were admitted with AHF through ED during 1 July 2017 to 31 Dec 2019. Door-to-furosemide (D2F) time was defined as the time from patient arrival at the ED to the first intravenous furosemide injection within 24 hours. Patients with a D2F time ≤60 min were classified as the early treatment group. Primary outcome was in-hospital mortality and secondary outcomes were in-hospital morbidities. Adjusted odd ratio and the 95% confidence interval (CI) were represented using multiple logistic regression adjusted for age, sex, weight, furosemide dose, and baseline serum creatinine. Results Among 820 enrolled AHF patients, the median D2F time was 80.5 min (interquartile range: 42 to 187 min). of those 324 (39%) patients were categorized into early D2F time group. The rate of total in-hospital death was 4.9% and did not differ between groups (3.1% vs. 6%, early vs delayed D2F group; p=0.067). In multivariate analysis, early treatment is not significantly associated with lower in-hospital mortality (odd ratio: 0.57; 95% CI: 0.27–1.23; p=0.152) as well as secondary endpoints. Conclusions In this small single-center study, early treatment with furosemide was uncommon. Less than half of admitted patients were received furosemide within 1 hour. In-hospital mortality was double in delayed group but was not statistically significant. FUNDunding Acknowledgement Type of funding sources: None.

Mechanical Circulatory Support in Advanced Heart Failure: Single-Center Experience

2014 ◽  
Vol 46 (5) ◽  
pp. 1476-1480
Author(s):  
A. Loforte ◽  
A. Montalto ◽  
P. Lilla della Monica ◽  
A. Lappa ◽  
C. Contento ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mechanical Circulatory Support ◽  
Advanced Heart Failure ◽  
Circulatory Support ◽  
Single Center ◽  
Single Center Experience
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