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Acute and Advanced Heart Failure Blog

Professor Gerhard Pölzl is Chief of the Heart Failure and Heart Transplant Program at the Medical University Innsbruck. His research is focused on clinical studies in advanced and chronic heart failure and on translational studies in cardiomyopathies.

He has been Principal Investigator of the LevoRep clinical trial that tested the efficacy and safety of pulsed infusions of levosimendan in outpatients with advanced heart failure. He is now P.I. of the clinical trial LEODOR, on repetitive use of levosimendan in advanced heart failure.

This blog is focused on the therapeutic options for Acute and Advanced Heart Failure: new data, new studies, new opinions, new trends.


Latest posts

7 February 2019

February 2019 post

Maximizing benefits of levosimendan for patients for 30 years  - and the work continues..

If newspapers are the first draft of history for the lay public, posters and abstracts serve the same role for scientists and clinicians. We might therefore conclude that levosimendan has been making history for 30 years, since it first appeared in congress posters and abstracts in the late eighties. The volume of research material generated during those years has been quite remarkable, with many hundreds of reports being published since the start of the present century. Abstracts on levosimendan can be found at key annual congresses of scientific and clinical societies such as the ESC, the HFA, the ISICEM, the ESICM, the EACTA, the EACTS and more.

Communications at congresses on levosimendan span between preclinical pharmacology and a series of clinical investigative phases, some of which remain as interesting observations, others of which ripen into new or enlarged clinical applications or offer a side-light on contemporary clinical practice (as in the 2011 report by Dr JT Parissis et al on ” Gender-related differences in clinical phenotype and in-hospital management in patients with acute heart failure: an ALARM-HF survey sub-analysis.").

All in all, Levosimendan continues to excite the imagination of scientists and researchers in all those directions.

In the sphere of clinical development, recent years have witnessed a concentrated emphasis on exploiting the unique qualities of levosimendan to maximize benefit to patients with acute or advanced heart failure. Contributions in this area have included a large, important and still growing literature describing first-hand experience with levosimendan in the day-to-day management of these cases. As part of these investigations we have also seen in very recent years expansion of research into matters such as the impact of levosimendan on renal function in heart failure, the use of intermittent levosimendan as a bridge to heart transplant and the use of this drug in the context of ECMO treatment.

Another step in the evolution of this remarkable and versatile agent is now in progress with the recent presentation by Dr Merit Cudkowicz et al. of the protocol of the REFALS 3 trial, which will evaluate the impact of levosimendan on respiratory function in patients with acute lateral sclerosis (ALS). Details of this ambitious trial are available via www.ClinicalTrails.gov (ClinicalTrials.gov Identifier: NCT03505021).

 

 

10 January 2019

January 2019 post

Supplement to the European Heart Journal

The new year is up and running and I take this opportunity to wish all visitors and subscribers to www.simdax.com good health and fulfillment in 2019.

My first blog post of the year is an invitation to you all to take a look at a supplement to the European Heart Journal that hit the bookshelves right at the end of 2018. I must declare an interest in the matter as I was the Supplement Editor but, even allowing for the natural pride in ownership that position evokes, I think this is a commendable addition to the literature on acute and advanced heart failure and will reward readers’ attention.

The bone and muscle of the essays this Supplement was provided by my 16 distinguished fellow physicians from across Europe. Space prevents me name-checking them all here and to be selective would intolerable but their credentials as commentators on these matters are undisputed and their thoughts on these subjects merit our attention.

I’m going to pick out two thoughts of my own, from my Editorial, to try and convey the enquiring tone of these essays and to encourage you to give the full Supplement some of your time.

“Patients [with Advanced Heart Failure] are vulnerable to repeated cycles of decompensation and hospitalization. Such episodes are debilitating for the patient and expensive for the health system. If we can intervene to restore equilibrium to patients in the vital time between the start of a phase of deterioration and the eventual hospitalization we could contribute significantly to their health-related quality of life and spare them the disappointment of yet another unscheduled hospital admission.”

“There is certainly enough evidence to identify levosimendan as one valuable element in an overall strategy of care directed towards maintaining patients in a condition of out-of-hospital stability.”

 

Citations

Poelzl G. Levosimendan in acute and advanced heart failure: still some chapters to be written. I1: 20(Suppl I):2018.

Harjola V-P et al. Use of levosimendan in acute heart failure. European Heart Journal Supplements. I2-I10: 20(Suppl I):2018.

Oliva F et al. Repetitive levosimendan treatment in the management of advanced heart failure. I11-I20: 20(Suppl I):2018.

3 December 2018

December 2018 post

Levosimendan Ends 2018 on a High Note

Earlier this year (May 27-28), the Heart Failure 2018 congress of the European Society of Cardiology-Heart Failure Association convened in Vienna, Austria.  A series of tutorials delivered by experts from nine European countries examined how to use levosimendan safely and effectively in acute and advanced heart failure, including in the context of renal dysfunction.

Contributors to that lecture series have now distilled into print their experience and views on the position of levosimendan in the management of acute and advanced heart failure in a review published in Cardiovascular Drugs and Therapy (Bouchez S et al. 2018 Nov 6. doi: 10.1007/s10557-018-6838-2. [Epub ahead of print]). It seems fitting that we should conclude our monthly blog posts for 2018 with a brief summary of this excellent tour d’horizon from a group of notable and respected practitioners in this complex field.

A series of major points emerged from this review.

(1)  Meta-analyses of levosimendan data in various settings, including AHF and AdHF, indicated a trend towards a survival benefit that reached statistical significance in some investigations, though not all. Of note, however, none of these meta-analyses produced any indication that the use of levosimendan is associated with an increase of mortality, whereas a worsening impact on survival has been reported for other inotropes or inodilators.

(2)  In advanced heart failure meta-analysis indicates a clear and consistent effect of levosimendan to reduce re-hospitalizations. Given that patients with AdHF may comprise up to 10% of the overall heart failure population these benefits may be accessible to substantial numbers of patients.

(3)  Bouchez and colleagues re-iterate the advice of the authors of the 2016 ESC guidelines on acute and chronic heart failure, who recommend use of levosimendan in cases where there is concomitant use of beta-blockers.

(4)  Levosimendan both in the acute setting and in the repetitive/intermittent context of AdHF appears to a promising option to improve renal perfusion or to reverse or ameliorate renal dysfunction but further controlled trials are needed to confirm the status of levosimendan for this purpose. In particular, they emphasize the conclusions of Lannemyr et al. who recently suggested that levosimendan “could be the preferred inotropic agent for treatment of the cardiorenal syndrome”. (J Am Heart Assoc. 2018;7: e008455. doi: 10.1161/JAHA.117.008455.)

These are substantial attainments for any drug in these areas of heart failure therapy and they confirm levosimendan as a uniquely-configured resource for this field. Join us again in 2019 for the next chapters in the development of this remarkable agent.