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

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.