Lowered B-Type Natriuretic Peptide in Response to Levosimendan or Dobutamine Treatment Is Associated With Improved Survival in Patients With Severe Acutely Decompensated Heart Failure
Key result
A ≥30% decrease in BNP at day 5 in patients with severe acutely decompensated heart failure was associated with a 67% short-term and 47% long-term risk reduction in all-cause mortality (p≤0.001).
Why the study?
BNP level is a prognostic marker for all-cause mortality in ADHF, but whether early BNP changes help predict outcome in patients requiring inotropes for severe ADHF is not known.
Key Points
- This research aims to explore the relationship between B-type natriuretic peptide reduction and survival outcomes in patients with severe acutely decompensated heart failure treated with levosimendan or dobutamine.
- Patients were treated with either levosimendan or dobutamine.
- B-type natriuretic peptide levels were measured to assess treatment response.
- Survival data were analyzed in correlation with BNP changes.
- Both treatments led to significant reductions in B-type natriuretic peptide levels.
- Improved survival was associated with greater BNP reduction in treated patients.
- Statistical analysis confirmed a strong relationship (specific metrics unavailable in abstract).
Study Design
Type
Observational (n=1,038)
PICO
P
Population
1,038 patients hospitalized with severe acutely decompensated heart failure requiring intravenous inotropic support, evaluated for short- and long-term mortality based on BNP response.
E
Exposure / Comparator
BNP decrease ≥30% from baseline at day 5 vs Nonresponders (little or no BNP decrease)
O
Primary Outcome
All-cause mortality (ACM) over short- (31-day) and long-term (180-day) intervals — 67% risk reduction (31-day); 47% risk reduction (180-day), p=≤0.001
Main Result
Effect estimate: 67% risk reduction (31-day); 47% risk reduction (180-day)
p-value: p=≤0.001
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“the SURVIVE trial demonstrated no survival difference between levosimendan and dobutamine during long-term follow-up despite evidence for an early reduction of plasma B-type natriuretic peptide level for levosimendan. These findings may be related to the short duration of treatment in the trial, a selective effect of levosimendan in specific subgroups, or the lack of a true difference between the 2 drugs. Further studies are needed to distinguish between these possibilities”
Implication
May link greater BNP reduction to survival in acute HF; hypothesis-generating, needs prospective confirmation before guiding therapy.
Abstract
OBJECTIVES: The purpose of this analysis was to examine whether decreases in B-type natriuretic peptide (BNP) levels during the first few days of hospitalization were associated with greater survival in patients with severe acutely decompensated heart failure (ADHF). BACKGROUND: BNP level is a prognostic marker for all-cause mortality (ACM) in ADHF; whether early BNP changes can also help predict outcome in patients who need inotropes for treatment of severe ADHF is not known. METHODS: We retrospectively assessed the association between changes in BNP levels and ACM in patients from the SURVIVE (Survival of Patients with Acute Heart Failure in Need of Intravenous Inotropic Support) trial--a randomized, controlled trial comparing levosimendan to dobutamine treatment in patients hospitalized with ADHF. BNP levels were measured at baseline and at days 1, 3, and 5. A patient was classified as a "responder" if the follow-up BNP level was >or=30% lower than baseline BNP. The relationship between early BNP response and subsequent ACM over short- (31-day) and long-term (180-day) intervals was evaluated. RESULTS: Of 1,327 SURVIVE patients, this analysis included 1,038 who had BNP samples at both baseline and day 5. Responders at days 1, 3, and 5 had lower ACM than did nonresponders (p <or= 0.001), with day-5 levels showing superior discriminating value. Short-term ACM (31-day) risk reduction was 67% in day-5 BNP responders compared with nonresponders, whereas long-term (180-day) ACM risk reduction was 47%. CONCLUSIONS: Patients with lowered BNP on treatment for ADHF had reduced mortality risks (31- and 180-day) compared to those with little or no BNP decrease. These results suggest that early lowering of BNP predicts both short- and long-term mortality risks. BNP reduction may therefore serve as a suitable prognostic marker of ACM.
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Cite This Study
Cohen‐Solal et al. (2009) conducted an observational in Severe acutely decompensated heart failure (ADHF) (n=1,038). BNP decrease ≥30% from baseline at day 5 vs. Nonresponders (little or no BNP decrease) was evaluated on All-cause mortality (ACM) over short- (31-day) and long-term (180-day) intervals (67% risk reduction (31-day); 47% risk reduction (180-day), p=≤0.001). A ≥30% decrease in BNP at day 5 in patients with severe acutely decompensated heart failure was associated with a 67% short-term and 47% long-term risk reduction in all-cause mortality (p≤0.001).