Relationship between B-type natriuretic peptide plasma levels and echocardiography parameters in decompensated chronic heart failure patients treated with levosimendan

Background

B-type natriuretic peptide (BNP) plasma levels have recently been demonstrated as significant neurohormonal markers of chronic heart failure (CHF) progression and prognosis. Additionally, clinical studies have shown that the calcium sensitizer levosimendan beneficially affects the central hemodynamics of CHF patients and improves their long-term prognosis.

Purpose

To investigate whether levosimendan-induced hemo-dynamic improvement, as confirmed by echocardiogram of CHF patients, is related to respective changes in BNP levels.

Methods

Circulating levels of BNP were measured by ELISA in 37 patients with decompensated advanced CHF at baseline and 72 hours after the initiation of levosimendan treatment. Echo-cardiographic parameters – pulmonary artery pressure (PAP), end-diastolic volume (EDV), end-systolic volume (ESV) and left ventricular ejection fraction (LVEF) – were also measured at baseline and 72 hours after infusion initiation. We used the threshold of 500 pg/ml for BNP, 30 mmHg for PAP and 50% for LVEF to define patients as having altered results.

Results

We retrospectively analyzed 37 consecutive CHF patients to whom levosimendan was prescribed by the attending physician besides standard measures. BNP levels were significantly lower within 72 hours of levosimendan treatment (P < 0.01). A significant reduction of PAP (P < 0.05) was also found during the same period. A good correlation between the levosimendan-induced changes in LVEF and the respective reduction of BNP levels (P < 0.01) was observed.

Conclusion

Our results indicate that changes in BNP levels may be useful as biochemical markers of levosimendan-induced improvement in echocadiographic and clinical parameters.