CONGRESS ABSTRACT

INTRODUCTION. A 71-year-old man, with primary dilated cardiomyopathy with severe left ventricular dysfunction (LVDTD 60 mm, LVEF 20%), normal right ventricular function (RVDTD 36 mm, TAPSE 21 mm, RV S' TDI 11 cm/s) and moderate mitral regurgitation. In early 2019 he was hospitalized for heart failure and underwent implantation of a dual-chamber defibrillator in primary prevention with activation of a multiparametric algorithm for the management of heart failure1. At discharge, maximal drug therapy was confirmed. Since September 2022, the synthetic index for heart failure has exceeded the critical threshold, reaching a value of 17 and a remote control alert has been issued, requiring an increase in diuretic therapy. After a few months of clinical stability in December 2022 he complained of a progressive reduction in functional capacity, confirmed by an increase in the same index. DIAGNOSIS AND MANAGEMENT. Due to the appearance of a NYHA class III in February 2023, the patient, who on the echocardiogram presented a continuous decline in right ventricular function (TAPSE 12 mm, RV S' TDI 6 m/s), was hospitalized and underwent 4 cycles of biweekly infusion of Levosimendan2 with transient improvement of the clinical picture. In March 2023, a device for the modulation of cardiac contractility was implanted in the absence of acute complications (Fig.1).  Two months after the implant, a progressive improvement in the clinical conditions was observed, supported by a progressive decline in the heart failure index which returned to basic values ​​(Fig.2). On the echocardiogram, in the face of a stable left systolic function, a clear improvement in the right ventricular function indices was observed (Fig.3). Since December 24, the patient has no longer needed infusion therapy with Levosimendan for the stable recovery of a NYHA class II. CONCLUSION. Modulation of cardiac contractility is a method of proven effectiveness in patients with heart failure in reducing symptoms and preventing hospitalizations. The improvement in patient management is also highlighted by the reduction in volumes and contractile capacity of the right ventricle. The use of advanced algorithms integrated into defibrillation devices allows the effectiveness of this method to be evaluated even remotely.