title: Value of IGF-I levels in the evaluation of response to treatment with levosimendan in patients with severe heart failure.
abstract: OBJECTIVE
  Levosimendan treatment has inotropic, anti-stunning, and cardioprotective effects in the setting of acute decompensated heart failure (HF). Among studies conducted on the treatment of heart failure, those based on the growth hormone axis are of particular interest. The aim of this study was to determine the value of baseline insulin-like growth factor 1 (IGF-I) measurements in predicting response to levosimendan treatment.
  
  
  METHODS
  The study population included patients on standard heart failure treatment who presented with functional capacity NYHA class 3-4 and left ventricular (LV) ejection fraction less than 35% were enrolled in this prospective, cohort study. Pre- and post-treatment symptoms of patients (72 hours after the completion of levosimendan infusion) and echocardiographic parameters were evaluated and blood samples were collected. Mann-Whitney U, Pearson Chi-square and Wilcoxon Sign Rank tests were used for statistical analysis. Correlations were determined using Spearman correlation analysis.
  
  
  RESULTS
  Thirty patients were enrolled in this study, 83.3% of whom were male and 16.7% were female, with a mean age of 62.6 ±10.1 years. Mean baseline IGF-I level was 106.9±47.0 µg/L. Statistically significant improvements were observed in NYHA class, mean brain natriuretic peptide (BNP) levels, LV ejection fraction and LV end-systolic volume values following treatment with levosimendan (respective pre-treatment and post-treatment values: 3.5±0.5 vs. 2.5±0.7, p<0.001; 1209.8±398.6 pg/ml vs. 704.1±344.6 pg/ml, p<0.001, and 25.7±6.6% vs. 29.0±6.8%, p=0.021, and 164.1±45.7 ml vs. 152.8±50.6 ml, p=0.012). Fourteen patients (46.7%) had low IGF-I levels, taking into consideration variations due to age and gender. Patients with normal baseline IGF-I values showed more significant decreases in BNP levels in response to treatment compared to those with low baseline IGF-I levels (650.5±367.2 pg/ml vs. 340.1±269.0 pg/ml, p=0.014).
  
  
  CONCLUSIONS
  Baseline IGF-I levels may be used to predict response to levosimendan treatment in patients hospitalized for decompensated HF.
authors.affiliation: Clinic of Endocrinology and Metabolism, Ministry of Health Ankara Numune Research and Training Hospital, Turkey. isik_serhat@yahoo.com
authors.forename: Serhat
authors.initials: S
authors.lastname: Işık
authors.forename: Mustafa
authors.initials: M
authors.lastname: Cetin
authors.forename: Hülya
authors.initials: H
authors.lastname: Ciçekçioğlu
authors.forename: Ozgül
authors.initials: O
authors.lastname: Uçar
authors.forename: Zehra Güven
authors.initials: ZG
authors.lastname: Çetin
authors.forename: Ufuk
authors.initials: U
authors.lastname: Ozuğuz
authors.forename: Fatih
authors.initials: F
authors.lastname: Bakır
authors.forename: Dilek
authors.initials: D
authors.lastname: Berker
authors.forename: Serdar
authors.initials: S
authors.lastname: Güler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage / Q000627:therapeutic use*; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011724:Pyridazines / Q000008:administration & dosage / Q000627:therapeutic use*; D012720:Severity of Illness Index; D000077464:Simendan; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D020097:Natriuretic Peptide, Brain; D000077464:Simendan; D007334:Insulin-Like Growth Factor I