Simendan – ABC CARDIOL

ABCHF

Viewpoint

The Heart Transplant Prioritization System in Brazil: Challenges and Perspectives on the Use of Home Inotropes

Helena Garcia Betinardi Bernardi et al. Edimar Alcides Bocchi

Introduction

Despite advances in the treatment of heart failure with reduced ejection fraction (HFrEF), the disease still represents a significant clinical challenge, especially in advanced stages. It is estimated that up to 13% of patients do not respond to conventional therapies, progressing to severe forms of the syndrome, which are associated with high morbidity and mortality.^,

Globally, about 64 million people live with HF, and in Brazil, 941,576 hospitalizations due to HF were recorded between 2019 and 2023, with a progressive increase during this period. In 2023, the incidence was 101.83 cases per 100,000 inhabitants. These numbers reflect not only the magnitude of the problem but also the burden it imposes on the healthcare system.

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ABCHF

Case Report

Reversal of Type 2 Pulmonary Hypertension after Levosimendan: A Challenging Approach Bringing New Insights

Helena Garcia Betinardi Bernardi et al. Deborah de Sá Pereira Belfort Bruno Biselli Paulo Roberto Chizzola … Robinson Tadeu Munhoz Silvia M. Ayub-Ferreira Edimar Alcides Bocchi

Abstract

Among the inotropic agents used in the management of heart failure, levosimendan, in particular, has a selective venodilator property that appears to explain its clinical benefit during pulmonary hypertension (PH). Most of the evidence refers to patients with group 2 PH and consequent right ventricular (RV) dysfunction. In this scenario, the observed benefits may be due to the effect of levosimendan on RV contractility and pulmonary vessel dilation, or to the improvement of left ventricular function and consequent reduction of pulmonary congestion. What we have noticed is that more and more studies are being done on this action and applicability of the drug, appearing in small studies, reviews and formal indications.

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Original Article

Levosimendan and Atrial Fibrillation: A Meta-Analysis of Randomized Controlled Trials

Huan Wan et al. Jihua Feng Pan Ji Wei Chen Jianfeng Zhang

Abstract

Background

Atrial fibrillation (AF) is a prevalent complication associated with levosimendan; however, it remains uncertain whether there are any disparities in the effects of levosimendan on non-postoperative and postoperative AF.

Objectives

This study aimed to evaluate the levosimendan effect on non-postoperative and postoperative AF by conducting a meta-analysis of randomized control trials (RCTs).

Methods

PubMed, Embase, Cochrane Library, and other databases were searched. Pairs of reviewers identified RCTs that compared levosimendan and placebo or other therapies, and the results reported AF events data. Random effects models were used (at a significance level of 5%).

Results

Twenty-nine eligible trials comprising 6550 participants were included, eleven of which evaluated the non-postoperative AF incidence, and 18 included postoperative AF. The analysis revealed that levosimendan elevated the AF risk significantly in the non-postoperative group (OR, 1.62; 95% CI: 1.19-2.20; p=0.002) and reduced the AF incidence in the postoperative group (OR, 0.65; 95% CI: 0.44-0.96; p=0.03). AF occurrence decreased more significantly in patients who used levosimendan after cardiac surgery (OR, 0.53; 95% CI: 0.32-0.88; p=0.02) than in patients who used levosimendan before cardiac surgery (OR, 0.67; 95% CI: 0.42-1.06; p=0.09). Moreover, The AF risk was significantly elevated by levosimendan large bolus dose (bolus dose≥12 μg/kg) (OR, 1.44; 95% CI: 1.10-1.88; p=0.004) and decreased by small bolus dose of levosimendan (bolus dose<12 μg/kg) (OR, 0.64; 95% CI: 0.34-1.20; p=0.16).

Conclusion

Levosimendan was linked to an increased non-postoperative AF incidence. The employment of levosimendan was effective in preventing postoperative AF.

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The Heart Transplant Prioritization System in Brazil: Challenges and Perspectives on the Use of Home Inotropes

Introduction

Reversal of Type 2 Pulmonary Hypertension after Levosimendan: A Challenging Approach Bringing New Insights

Abstract

Levosimendan and Atrial Fibrillation: A Meta-Analysis of Randomized Controlled Trials

Abstract

Background

Objectives

Methods

Results

Conclusion

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Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)

Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)