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Levosimendan use in patients with acute heart failure and reduced ejection fraction with or without severe renal dysfunction in critical cardiac care units: a multi-institution database study

BACKGROUND: Acute heart failure is a life-threatening clinical condition. Levosimendan is an effective inotropic agent used to maintain cardiac output, but its usage is limited by the lack of evidence in patients with severely abnormal renal function. Therefore, we analyzed data of patients with acu...

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Autores principales: Chan, Cze-Ci, Lee, Kuang-Tso, Ho, Wan-Jing, Chan, Yi-Hsin, Chu, Pao-Hsien
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869075/
https://www.ncbi.nlm.nih.gov/pubmed/33555483
http://dx.doi.org/10.1186/s13613-021-00810-y
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author Chan, Cze-Ci
Lee, Kuang-Tso
Ho, Wan-Jing
Chan, Yi-Hsin
Chu, Pao-Hsien
author_facet Chan, Cze-Ci
Lee, Kuang-Tso
Ho, Wan-Jing
Chan, Yi-Hsin
Chu, Pao-Hsien
author_sort Chan, Cze-Ci
collection PubMed
description BACKGROUND: Acute heart failure is a life-threatening clinical condition. Levosimendan is an effective inotropic agent used to maintain cardiac output, but its usage is limited by the lack of evidence in patients with severely abnormal renal function. Therefore, we analyzed data of patients with acute heart failure with and without abnormal renal function to examine the effects of levosimendan. METHODS: We performed this retrospective cohort study using data from the Chang Gung Research Database (CGRD) of Chang Gung Memorial Hospital (CGMH). Patients admitted for heart failure with LVEF ≤ 40% between January 2013 and December 2018 who received levosimendan or dobutamine in the critical cardiac care units (CCU) were identified. Patients with extracorporeal membrane oxygenation (ECMO) were excluded. Outcomes of interest were mortality at 30, 90, and 180 days after the cohort entry date. RESULTS: There were no significant differences in mortality rate at 30, 90, and 180 days after the cohort entry date between the levosimendan and dobutamine groups, or between subgroups of patients with an estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m(2) and eGFR < 30 mL/min/1.73 m(2) or on dialysis. The results were consistent before and after propensity score matching. CONCLUSIONS: Levosimendan did not increase short- or long-term mortality rates in critical patients with acute heart failure and reduced ejection fraction compared to dobutamine, regardless of their renal function. An eGFR less than 30 mL/min/1.73 m(2) was not necessarily considered a contraindication for levosimendan in these patients.
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spelling pubmed-78690752021-02-09 Levosimendan use in patients with acute heart failure and reduced ejection fraction with or without severe renal dysfunction in critical cardiac care units: a multi-institution database study Chan, Cze-Ci Lee, Kuang-Tso Ho, Wan-Jing Chan, Yi-Hsin Chu, Pao-Hsien Ann Intensive Care Research BACKGROUND: Acute heart failure is a life-threatening clinical condition. Levosimendan is an effective inotropic agent used to maintain cardiac output, but its usage is limited by the lack of evidence in patients with severely abnormal renal function. Therefore, we analyzed data of patients with acute heart failure with and without abnormal renal function to examine the effects of levosimendan. METHODS: We performed this retrospective cohort study using data from the Chang Gung Research Database (CGRD) of Chang Gung Memorial Hospital (CGMH). Patients admitted for heart failure with LVEF ≤ 40% between January 2013 and December 2018 who received levosimendan or dobutamine in the critical cardiac care units (CCU) were identified. Patients with extracorporeal membrane oxygenation (ECMO) were excluded. Outcomes of interest were mortality at 30, 90, and 180 days after the cohort entry date. RESULTS: There were no significant differences in mortality rate at 30, 90, and 180 days after the cohort entry date between the levosimendan and dobutamine groups, or between subgroups of patients with an estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m(2) and eGFR < 30 mL/min/1.73 m(2) or on dialysis. The results were consistent before and after propensity score matching. CONCLUSIONS: Levosimendan did not increase short- or long-term mortality rates in critical patients with acute heart failure and reduced ejection fraction compared to dobutamine, regardless of their renal function. An eGFR less than 30 mL/min/1.73 m(2) was not necessarily considered a contraindication for levosimendan in these patients. Springer International Publishing 2021-02-08 /pmc/articles/PMC7869075/ /pubmed/33555483 http://dx.doi.org/10.1186/s13613-021-00810-y Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Research
Chan, Cze-Ci
Lee, Kuang-Tso
Ho, Wan-Jing
Chan, Yi-Hsin
Chu, Pao-Hsien
Levosimendan use in patients with acute heart failure and reduced ejection fraction with or without severe renal dysfunction in critical cardiac care units: a multi-institution database study
title Levosimendan use in patients with acute heart failure and reduced ejection fraction with or without severe renal dysfunction in critical cardiac care units: a multi-institution database study
title_full Levosimendan use in patients with acute heart failure and reduced ejection fraction with or without severe renal dysfunction in critical cardiac care units: a multi-institution database study
title_fullStr Levosimendan use in patients with acute heart failure and reduced ejection fraction with or without severe renal dysfunction in critical cardiac care units: a multi-institution database study
title_full_unstemmed Levosimendan use in patients with acute heart failure and reduced ejection fraction with or without severe renal dysfunction in critical cardiac care units: a multi-institution database study
title_short Levosimendan use in patients with acute heart failure and reduced ejection fraction with or without severe renal dysfunction in critical cardiac care units: a multi-institution database study
title_sort levosimendan use in patients with acute heart failure and reduced ejection fraction with or without severe renal dysfunction in critical cardiac care units: a multi-institution database study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869075/
https://www.ncbi.nlm.nih.gov/pubmed/33555483
http://dx.doi.org/10.1186/s13613-021-00810-y
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