Plasma B-type natriuretic peptide reduction predicts long-term response to levosimendan therapy in acutely decompensated chronic heart failure.
OBJECTIVE
We sought to identify predictors of long-term response to levosimendan therapy among patients' baseline features and treatment-induced changes in acutely decompensated chronic heart failure (ADHF).


METHODS
Ninety-eight consecutive patients [aged 64+/-10 years, New York Heart Association (NYHA) classes III-IV, left ventricular ejection fraction <35%], 69 treated with levosimendan and 29 with standard therapy, underwent a clinical, echocardiographic and biochemical assessment before and after treatment. All patients were subsequently followed for 6 months for death or rehospitalization for ADHF.


RESULTS
Compared to standard therapy, levosimendan induced a significant improvement in NYHA class (F=37.529, p<0.001), B-type natriuretic peptide (BNP, F=22.917, p<0.001), left ventricular ejection fraction (F=23.561, p<0.001), transmitral E deceleration time (DT, F=6.499, p=0.013) and E/e ratio (F=10.812, p=0.003). During follow-up, 88 of 98 patients (90%) experienced an event. Event-free survival (days alive and out of hospital) at 6 months was similar in two groups (median, 48 days, log-rank test p=0.6760). In the levosimendan group, treatment-induced percent BNP change was the best predictor of events (OR=0.970, 95% CI=0.954-0.986, p<0.001). A cut-off for BNP change of 58% predicted events with 87% sensitivity and 83% specificity. Event-free survival was longer in patients with a BNP reduction > or =58% (median, 135 versus 43 days, p=0.0001).


CONCLUSIONS
Treatment-induced BNP reduction is an independent predictor of 6-month outcome following levosimendan therapy in ADHF.
Farmakis
Dimitrios
D
Second Department of Cardiology and Heart Failure Unit, Attiko University Hospital, Athens, Greece. dimitrios_farmakis@yahoo.com
Parissis
John T
JT
Bistola
Vassiliki
V
Paraskevaidis
Ioannis A
IA
Iliodromitis
Efstathios K
EK
Filippatos
Gerasimos
G
Kremastinos
Dimitrios T
DT
D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006334:Heart Function Tests; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011724:Pyridazines / Q000627:therapeutic use*; D012680:Sensitivity and Specificity; D000077464:Simendan; D014463:Ultrasonography
D015415:Biomarkers; D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D020097:Natriuretic Peptide, Brain; D000077464:Simendan