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Experience with Levosimendan in Cardiogenic Shock: Inotrope Weaning and Clinical Outcomes in a Real-World Cohort
Session:
Sessão de Posters 23 - Choque cardiogénico: preditores, suporte e desfechos
Speaker:
Mariana Rocha Morato Silveira Ramos
Congress:
CPC 2026
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
14. Acute Cardiac Care
Subtheme:
14.4 Acute Cardiac Care – Cardiogenic Shock
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Mariana Silveira Ramos; Margarida Matias; Raquel Montalvão; Gonçalo Cunha; Rita Bello; João Presume; Christopher Strong; Jorge Ferreira; Catarina Brizido
Abstract
<p style="text-align:justify"><strong>Background:</strong> Cardiogenic shock (CS) is associated with high mortality and frequent dependence on inotropes. Levosimendan has been proposed to facilitate weaning from inotropes and mechanical circulatory support (MCS), but real-world evidence is limited.</p> <p style="text-align:justify"><strong>Objectives:</strong> To describe our experience with levosimendan use in CS, focusing on inotrope weaning, safety, and prognostic factors.</p> <p style="text-align:justify"><strong>Methods:</strong> We conducted a retrospective observational study including 77 patients treated with levosimendan for CS between January 2017 and August 2025. Data collected included demographics, etiology, timing and success of catecholamine and/or MCS withdrawal, maximum tolerated dose, adverse events, and contraindications. Between-group comparisons were performed using chi-square or Fisher’s exact tests for categorical variables and Student’s t-test or Mann–Whitney U test for continuous variables, as appropriate. One-year mortality was assessed using Kaplan–Meier survival analysis and compared between groups using the log-rank (Mantel–Cox) test.</p> <p style="text-align:justify"><strong>Results: </strong>Mean age was 64±16 years; 78% were male. CS etiologies were post-acute myocardial infarction (51%), acute non-ischemic (13%), acute-on-chronic (36%). The main indication for levosimendan was inotrope weaning (67.5%), followed by combined inotrope and MCS weaning (24.7%), and hypoperfused acute decompensated heart failure (HF) (7.8%). Complete inotrope withdrawal was achieved within 48 hours in 44.2% of patients, within one week in 29.9%, while 26.0% remained inotrope-dependent. 11 patients (15%) required repeated infusions; 4 were referred to a levosimendan day-hospital program. During hospitalization, 30 patients died, 10 underwent heart transplantation, and 4 received a left ventricular assist device (LVAD). 12 patients experienced a cardiovascular-related hospital readmission; among them, 9 (75%) were readmitted for decompensated HF, and 4 of these (33%) required a new levosimendan infusion cycle. The maximum infusion rate (0.2mcg/kg/min) was tolerated in 88% of cases. Adverse events occurred in 13%, mainly arrhythmias (11.7%). No severe adverse events occurred. 48 patients (62%) had no relative contraindications. Among those with relative contraindications, the most frequent were elevated ALT (24.7%) and renal replacement therapy (6.5%). There were no significant associations with 1-year mortality for maximum dose tolerance (49.3% vs 44.4%; p=0.958), occurrence of adverse events (42.9% vs 50.8%; p=0.751), or the presence of a relative contraindication (57.1% vs 45.8%; p=0.291).</p> <p style="text-align:justify"><strong>Conclusions:</strong> Levosimendan appears to be a well-tolerated and safe option in CS, with modest efficacy in facilitating inotrope withdrawal. Failure to tolerate the maximum dose, occurrence of adverse events, or presence of relative contraindications were not significant predictors of worse 1-year mortality outcomes.</p>
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