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 >= 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) (J Am Coll Cardiol 2009; 53: 2343-8) (C) 2009 by the American College of Cardiology Foundation