title: Effects of levosimendan/furosemide infusion on plasma brain natriuretic peptide, echocardiographic parameters and cardiac output in end-stage heart failure patients.
abstract: BACKGROUND
  Acute decompensation heart failure (ADHF) remains a cause of hospitalization in patients with end-stage congestive HF. The administration of levosimendan in comparison with a standard therapy in CHF patients admitted for ADHF was analysed.
  
  
  METHODS
  Consecutive patients admitted for ADHF (NYHA class III-IV) were treated with levosimendan infusion 0.1 µg/kg/min or with furosemide infusion 100-160 mg per day for 48 hours (control group). All subjects underwent determination of brain natriuretic peptide (BNP), non-invasive cardiac output (CO), and echocardiogram at baseline, at the end of therapy and 1 week after therapy.
  
  
  RESULTS
  Seven patients admitted for 20 treatments in 16 months (age 66 years; mean admission/year 5.4) were treated with levosimendan and compared with 7 patients admitted for 15 treatments (age 69.1 years; mean admission/year 6.1). At the end of levosimendan therapy, BNP decreased (from 679.7 ± 512.1 pg/ml to 554.2 ± 407.6 pg/ml p = 0.03), and 6 MWT and LVEF improved (from 217.6 ± 97.7 m to 372.2 ± 90.4 m p = 0.0001; from 22.8 ± 9.1% to 25.4 ± 9.8% p = 0.05). Deceleration time, E/A, E/E', TAPSE, pulmonary pressure and CO did not change significantly after levosimendan therapy and after 1 week. At follow-up, only 6-min WT and NYHA class showed a significant improvement (p = 0.0001, p = 0.001 respectively). The furosemide infusion reduced NYHA class and body weight (from 3.4 ± 0.6 to 2.3 ± 0.5 p = 0.001; from 77.5 ± 8.6 kg to 76 ± 6.6 kg p = 0.04), but impaired renal function (clearances from 56.3 ± 21.9 ml/min to 41.2 ± 10.1 ml/min p = 0.04).
  
  
  CONCLUSIONS
  Treating end-stage CHF patients with levosimendan improved BNP and LVEF, but this effect disappeared after 1 week. The amelioration of 6 MWT and NYHA class lasted longer after levosimendan infusion.
authors.affiliation: Cardiovascular Rehabilitation-Heart Failure Unit Ospedale SS Trinita', Fossano, Italy. m_feola@virgilio.it
authors.forename: Mauro
authors.initials: M
authors.lastname: Feola
authors.forename: Enrico
authors.initials: E
authors.lastname: Lombardo
authors.forename: Camillo
authors.initials: C
authors.lastname: Taglieri
authors.forename: Paola
authors.initials: P
authors.lastname: Vallauri
authors.forename: Salvatore
authors.initials: S
authors.lastname: Piccolo
authors.forename: Roberto
authors.initials: R
authors.lastname: Valle
mesh_terms: D000368:Aged; D002302:Cardiac Output / Q000502:physiology*; D016022:Case-Control Studies; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D005665:Furosemide / Q000008:administration & dosage / Q000627:therapeutic use*; D006333:Heart Failure / Q000097:blood* / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011724:Pyridazines / Q000008:administration & dosage / Q000627:therapeutic use*; D000077464:Simendan; D013997:Time Factors
chemical_list: D006835:Hydrazones; D011724:Pyridazines; D020097:Natriuretic Peptide, Brain; D000077464:Simendan; D005665:Furosemide