Abstract 2947: Effects of Serial Levosimendan Infusions on Left Ventricular Remodeling and Plasma Biomarkers of Myocardial Injury and Neurohormonal Activation in Patients with Advanced Heart Failure
Background: Levosimendan is a novel inodilator that improves central hemodynamics and symptoms of patients with advanced heart failure (HF). The role, however, of repeated levosimendan infusions in the management of these patients has not been properly assessed.
Purpose: This prospective randomized placebo-controlled trial investigated the effects of serial levosimendan administrations on cardiac geometry and function and on biomarkers of myocardial injury and neurohormonal and immune activation (Troponin-T, NT-proBNP, C-reactive protein, interleukin-6) in advanced HF. Twenty five patients with advanced HF [NYHA class III-IV, left ventricular (LV) ejection fraction < 30%] were randomized (2:1) to receive five serial 24-hour infusions (every 3 weeks) of either levosimendan 0.1 μg/Kg/min (n = 17) or placebo (n = 8), and evaluated echocardiographically and biochemically before and after each drug administration and 30 days after the final administration.
Results: Post-treatment, LV end-diastolic (133 ± 25 vs 120 ± 28 ml/m2, p < 0.01) and end-systolic volume indexes (95 ± 28 vs 80 ± 25 ml/m2, p < 0.05) were significantly reduced only in the levosimendan-treated patients. A significant decrease of NT-pro BNP (1547 ± 347 vs 966 ± 363 pg/ml, p < 0.01), high-sensitivity C-reactive protein (9.3 ± 2.5 vs 7.2 ± 4.1 ng/ml, p < 0.01) and plasma interleukin-6 (13.1 ± 3.8 vs 10.8 ± 7.2 pg/ml, p = 0.05) was also observed in the levosimendan group, while these markers remained unchanged in the placebo group; similar changes were observed after each single drug infusion. Troponin-T remained unchanged after each levosimendan administration and at the final evaluation, while it was significantly increased in the placebo arm (p < 0.05).
Conclusion: Serial levosimendan administrations improved LV geometry and modulated beneficially neurohormonal and immune activation in advanced HF, without causing myocardial injury.