This Article Figures Only Full Text Full Text (PDF) View Related Journal Scan on Cardiosource Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (5) Citing Articles via Google Scholar Google Scholar Articles by Cohen-Solal, A. Articles by Mebazaa, A. Search for Related Content PubMed PubMed Citation Articles by Cohen-Solal, A. Articles by Mebazaa, A. Related Collections Related Articles

CLINICAL RESEARCH: HEART FAILURE

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

Alain Cohen-Solal, MD, PhD^_*,_*, Damien Logeart, MD^_*, Bidan Huang, PhD, Danlin Cai, PhD, Markku S. Nieminen, MD and Alexandre Mebazaa, MD, PhD^_*

^_* Hospital Lariboisière, Assistance Publique–Hopitaux de Paris, and Faculté de Médecine Denis Diderot, INSERM U 942, Paris, France
Abbott Laboratories, Abbott Park, Illinois
University Central Hospital, Helsinki, Finland

Manuscript received September 2, 2008; revised manuscript received January 20, 2009, accepted February 3, 2009.

^_* Reprint requests and correspondence: Prof. Alain Cohen-Solal, Département de Cardiologie, Hôpital Lariboisière, Universite Denis Diderot, INSERM U 942, 2 Rue A. Paré, Paris, 75475 Cedex 10, France (Email: alain.cohen-solal{at}lrb.aphp.fr).

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 ran-domized, 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 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 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. (Survival of Patients With Acute Heart Failure in Need of Intravenous Inotropic Support [SURVIVE]; NCT00348504)

Key Words: B-type natriuretic peptide • prognosis • acute decompensation of heart failure • levosimendan • dobutamine

Abbreviations and Acronyms   ACEI = angiotensin-converting enzyme inhibitor   ACM = all-cause mortality   ADHF = acute decompensation of heart failure   ANOVA = analysis of variance   BNP = B-type natriuretic peptide   ROC = receiver-operator characteristic

Related Articles

Are BNP Changes During Hospitalization for Heart Failure a Reliable Surrogate for Predicting the Effects of Therapies on Post-Discharge Mortality?

Mihai Gheorghiade and Peter S. Pang
J. Am. Coll. Cardiol. 2009 53: 2349-2352. [Full Text] [PDF]

This article has been cited by other articles:

				P. Karlstrom, U. Alehagen, K. Boman, U. Dahlstrom, and on behalf of the UPSTEP-study group Brain natriuretic peptide-guided treatment does not improve morbidity and mortality in extensively treated patients with chronic heart failure: responders to treatment have a significantly better outcome Eur J Heart Fail, October 1, 2011; 13(10): 1096 - 1103. [Abstract] [Full Text] [PDF]

				K. Thygesen, J. Mair, C. Mueller, K. Huber, M. Weber, M. Plebani, Y. Hasin, L. M. Biasucci, E. Giannitsis, B. Lindahl, et al. Recommendations for the use of natriuretic peptides in acute cardiac care: A position statement from the Study Group on Biomarkers in Cardiology of the ESC Working Group on Acute Cardiac Care Eur. Heart J., February 2, 2011; (2011) ehq509v1. [Full Text] [PDF]

				G. M. Felker and A. S. Maisel A Global Rank End Point for Clinical Trials in Acute Heart Failure Circ Heart Fail, September 1, 2010; 3(5): 643 - 646. [Full Text] [PDF]

				M. G. Link, G.-X. Yan, and P. R. Kowey Evaluation of Toxicity for Heart Failure Therapeutics: Studying Effects on the QT Interval Circ Heart Fail, July 1, 2010; 3(4): 547 - 555. [Full Text] [PDF]

				M. Gheorghiade and P. S. Pang Are BNP Changes During Hospitalization for Heart Failure a Reliable Surrogate for Predicting the Effects of Therapies on Post-Discharge Mortality? J. Am. Coll. Cardiol., June 23, 2009; 53(25): 2349 - 2352. [Full Text] [PDF]