Pathophysiology of the cardiorenal syndrome in acute heart failure

Effects of levosimendan in patients with acute heart failure and cardiorenal syndrome

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.028 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

M Ribeiro Da Silva ◽

G Santos Silva ◽

D Caeiro ◽

M Passos Silva ◽

C Guerreiro ◽

...

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Natriuretic Peptides ◽

Angiotensin Receptor Blockers ◽

Cardiorenal Syndrome ◽

Baseline Serum ◽

Beneficial Effects ◽

Funding Sources ◽

Tertiary Center ◽

Short Term Mortality

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiorenal syndrome (CRS) is common in patients with acute heart failure (AHF) and is associated with poor prognosis. Levosimendan (LVS) is an inodilator used in AHF and has beneficial effects on renal function (RF). However, its effects on RF in CRS patients are not established. Purpose To evaluate whether LVS could improve RF in AHF patients with or without CRS. Methods Retrospective study that included patients with AHF treated with LVS in a cardiac intensive care unit of a tertiary center, between January 2015 and June 2018. Baseline serum creatinine (SCr) was recorded and SCr and glomerular filtration rate (GFR) were accessed before and within 5 days after LSV use. CRS was defined as an increase in SCr > 0,3 mg/dL over baseline (before LVS use). RF improvement was defined as a decrease in SCr after LVS use. We evaluate outcomes at 1-year. Results 61 patients were included, 84% males, mean age 65 years, ejection fraction ≤40% in 87%. INTERMACS 4 and hemodynamic profile C were the most frequent presentation. LSV was administered in 24h, without bolus, in most patients. CRS was present in 44,3% of patients. Basal characteristics were similar between CRS and no-CRS patients, including prevalence of chronic kidney disease, baseline SCr or natriuretic peptides (p> 0,05 for all). CRS patients had a significant improvement in RF after LVS use (SCr 2,08 to 1,65 mg/dL, p< 0,001 and GFR 40,4 to 54,6 mL/min/m2, p< 0,001), while no-CRS patients had no significant improvement in RF (SCr 1,33 to 1,32 mg/dL and GFR 64,1 to 64,5 mL/min/m2, p> 0,05 for all). Also, there was a significant decrease in natriuretic peptides after LVS in CRS patients (NT-proBNP 13527,5 to 10708,8 pg/mL, p= 0,006), without significant differences in no-CRS patients. It is noteworthy that at discharge, CRS patients were more likely to titrate HF optimal medical therapy (OMT) compared with no-CRS patients (p= 0,039). There was a lower tendency to suspend angiotensin-converting enzyme (ACE-I) and angiotensin receptor blockers (ARB) in CRS patients (p= 0,05). At discharge CRS patients received more furosemide than at admission (77,2 mg/day to 97,1 mg/day, p= 0,019) compared with no-CRS patients (89,6 mg/day to 97,0 mg/day, p= 0,469), receiving similar doses at discharge. In CRS patients, RF improvement was associated with a decrease in intra-hospital mortality (p= 0,043) and a tendency to decrease 30-day mortality (p= 0,060), but without differences in one-year mortality. Conclusion In CRS patients, LVS improved RF and NT-proBNP, allowed to titrate OMT and decreased the need to suspend ACE-I or ARB and was associated to a decrease in short-term mortality.

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Cardiorenal syndrome in acute heart failure: A vicious cycle?

Revista Portuguesa de Cardiologia (English Edition) ◽

10.1016/j.repce.2013.09.011 ◽

2014 ◽

Vol 33 (3) ◽

pp. 139-146

Author(s):

Francisca Caetano ◽

Sérgio Barra ◽

Ana Faustino ◽

Ana Botelho ◽

Paula Mota ◽

...

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Cardiorenal Syndrome ◽

Vicious Cycle

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Markers of renal function and acute kidney injury in acute heart failure: definitions and impact on outcomes of the cardiorenal syndrome

European Heart Journal ◽

10.1093/eurheartj/ehq293 ◽

2010 ◽

Vol 31 (22) ◽

pp. 2791-2798 ◽

Cited By ~ 74

Author(s):

J. P. E. Lassus ◽

M. S. Nieminen ◽

K. Peuhkurinen ◽

K. Pulkki ◽

K. Siirila-Waris ◽

...

Keyword(s):

Heart Failure ◽

Acute Kidney Injury ◽

Renal Function ◽

Acute Heart Failure ◽

Kidney Injury ◽

Cardiorenal Syndrome

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Cardiorenal Syndrome in Acute Heart Failure: Revisiting Paradigms

Revista Española de Cardiología (English Edition) ◽

10.1016/j.rec.2014.10.016 ◽

2015 ◽

Vol 68 (5) ◽

pp. 426-435 ◽

Cited By ~ 4

Author(s):

Julio Núñez ◽

Gema Miñana ◽

Enrique Santas ◽

Vicente Bertomeu-González

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Cardiorenal Syndrome

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