Plasma B-type natriuretic peptide reduction predicts long-term response to levosimendan therapy in acutely decompensated chronic heart failure

Abstract 

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 ≥58% (median, 135 versus 43 days, p=0.0001).

Conclusion

Treatment-induced BNP reduction is an independent predictor of 6-month outcome following levosimendan therapy in ADHF.

Keywords: Levosimendan, Heart failure, Survival, Prognosis, Natriuretic peptides