Levosimendan in Heart Failure with Preserved Systolic Function

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The Journal of Heart and Lung Transplantation, Vol 36, No 4S, April 2017

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Implementation of an Informed Consent Process for Advanced Heart Failure Therapies: Defining the Population and Process C.H. Fine ,1 J. Gelow,2 J. Davis,2 J. Mudd,2 V. Herbl.2  1Internal Medicine, Oregon Health and Science, Portland, OR; 2Knight Cardiovascular Institute, Oregon Health and Science, Portland, OR.

WITHDRAWN

Purpose: Little information is available regarding standards and processes for identifying and evaluating Stage D heart failure (HF) patients for advanced therapies, posing challenges for clinical care, quality improvement and research. In December 2012, we implemented a formalized informed consent and advanced therapies evaluation process facilitated by a dedicated nurse coordinator. Here we describe the population consented for evaluation and the outcomes of this process. Methods: From 10/2012 to 5/2014, 83 patients signed informed consent to undergo evaluation for initial advanced HF therapies. Clinical characteristics and outcomes of the evaluation process were described. Frequencies and means and standard deviations were used to describe the populations. Differences were assessed with Chi-squared and t-tests. Results: Patients were 51.3 ± 13.7 years old, the majority of which were white men with nonischemic cardiomyopathy (Table 1). The evaluation process was completed in 74 patients. The average time from informed consent to initial Selection Conference (SC) presentation was 86.8 days ± 137.2 days. The outcome of initial SC is shown in Figure 1A. Thirty patients (deferred for transplant listing and/or ventricular assist device) were represented at SC. Outcomes of representation are shown in Figure 1B. Conclusion: A formalized consent and evaluation process provides a mechanism for identifying the characteristics and outcomes of patients undergoing evaluation for advanced HF therapies. This provides a platform for advancing clinical care, quality improvement and research.

5( 52) Levosimendan in Heart Failure with Preserved Systolic Function J. Goirigolzarri , J. Vazquez Lopez-Ibor, F.J. Hernandez, M. Gomez-Bueno, J.M. Solano-Lopez, D. Jimenez, L. Alonso-Pulpon, J. Segovia.  Hospital Universitario Puerta De Hierro Madrid Spain, Madrid, Spain. Purpose: End-stage Heart Failure (HF) frequently requires inotropic support. Due to its long-lasting effect Levosimendan (LSM) is an appealing option in this setting. However, the efficacy and safety of this drug in end-stage HF patients with preserved ejection fraction (EF over 40%) has not been described. The purpose was to analyze the use of LSM administration in patients with end-stage HF and EF over 40%. Methods: Patients with end-stage HF and EF over 40% admitted to our Cardiology department between 2010 and 2016 were included. Success of treatment was defined as symptomatic improvement (including those patients in which it allowed early posterior discharge) and/or NTproBNP decrease over 30% in the absence of death or rehospitalization at one month. Major cardiac events (mortality, heart transplantation and rehospitalization) during a 6-month follow-up were also analyzed. Results: 11 LSM administrations in 10 patients were analyzed. Median age was 53 years (IQR: 39-68) and median EF 60% (IQR: 42-60), with 8 patients (80%) suffering from at least moderate right ventricular failure. Etiology was restrictive cardiomyopathy (CM) in 3 patients, 2 hypertrofic CM, 2 patients with valvular disease, and one each of arrythmogenic CM, congenital disease and heart transplantation (HTX). Right heart catheterization (RHC) was performed in 5 patients, with a median cardiac index (CI) of 2,4 L/Min/m2 (IQR 2,1-2.8) and a PWP of 21 mmHg (IQR: 17-23). Success of treatment was achieved in 8 LSM administration (73%), as the 3 remaining were rehospitalized before the first month. NTproBNP was significantly reduced after LSM administration (median initial NTproBNP was 8271 (IQR: 2638-13782) and final 4063 (1873-18859), p < 0,05). At six months, 2 patients (20%) had died of progressive HF and 3 patients (30%) underwent HTX (1 of them died due to surgical complications). Of the 5 remaining patients, 4 were rehospitalized during the 6-month follow-up period. No major side effects or poor tolerance was reported. The overall survival rate at one year is 60% and survival free of HTX was 70%. Conclusion: LSM administration in this small series of patients with end stage HF and preserved EF was safe and achieved early symptomatic improvement and reduction of NTproBNP in a majority of patients. In few cases, it was used as a “bridge to transplant” strategy. Further studies are needed to confirm these results.

5( 53) WITHDRAWN  5( 54) Treatment with Sacubitril/Valsartan Regarding Evaluation for Heart Transplantation F.M. Strangl , M. Rybczinski.  Klinik für Allgemeine und Interventionelle Kardiologie, Universitäres Herzzentrum Hamburg, Hamburg, Germany. Purpose: The recently approved angiotensin receptor neprilysin inhibitor (ARNI) sacubitril/valsartan has gained representation in the 2016 ACC/AHA/ HFSA guideline update and the 2016 ESC guidelines. Wide experience with the substance in patients with terminal HF eligible for HTX is lacking. In an observational approach, we sought to determine to what extent the benefits of ARNI therapy apply in this context, whether the use is safe and whether it contributes to gaining clinical stability, and thus valuable time, in the process of HTX evaluation. Methods: 32 patients eligible for HTX evaluation received CHF treatment with sacubitril/valsartan. According to ESC guideline indications, CHF patients with reduced EF (≤  35%) and NYHA class II-III besides optimal medical treatment were considered eligible. Patients were summoned for