The calcium sensitizer levosimendan reduces the brain natriuretic peptide levels as compared with dobutamine in intensive care unit septic patients with decompensated heart failure

Introduction

The brain natriuretic peptide (BNP) is a useful index to follow-up patients with heart failure as well as a special diagnostic and prognostic tool. This study aims at investigating the impact of levosimendan in comparison with dobutamine on the BNP levels in ICU patients with decompensated heart failure related to septic shock. The role of levosimendan in septic patients is still under consideration.

Methods

Twenty-nine patients (20 males and nine females) of a 70.5 ± 9.2 average age rate with persisting left ventricular dysfunction related to severe sepsis, after receiving a 48-hour conventional treatment including inotropic agents, were randomised to either 24-hour i.v. levosimendan (0.2 γ/kg/min) (n = 15) (Group A) or dobutamine (5 γ/kg/min) (n = 14) (Group B) therapy. Serial BNP measurements were performed before, at 48 hours and 5 days later.

Results

Levosimendan therapy significantly reduced the BNP levels both in 48 hours and in 5 days as compared with dobutamine. Group A: 1,138 ± 93.7, 740.2 ± 106, 445 ± 118.3 and Group B: 1,561 ± 370.2, 1,436 ± 368, 1,850 ± 520.5, before, 48 hours and 5 days later, respectively. P = 0.025 for 48 hours and P = 0.037 for 5 days.

Conclusion

Levosimendan therapy reduces BNP levels, reflecting a beneficial haemodynamic effect on the ICU patient with septic myocardial depression.