NT-proBNP response to intermittent levosimendan and clinical outcomes in advanced heart failure
R Brandao, F Gerardo, L Cotrim, M Ribeiro, C Henriques, M Passos, A Oliveira Soares, I Fialho, D RoqueAbstract
Introduction
NT-proBNP is a well-established biomarker for risk stratification and monitoring in patients with heart failure (HF). However, the prognostic value of its temporal variation following specific therapeutic interventions, such as intermittent levosimendan, remains uncertain and poorly defined in advanced HF populations.
Objectives
Evaluate whether changes in NT-proBNP levels at six months (ΔNT-proBNP) are associated with adverse clinical outcomes, including all-cause mortality, HF readmissions, the need for levosimendan reinitiation, and a composite outcome encompassing these three events.
Methods
Retrospective, single-center study was conducted including 59 patients with advanced HF undergoing intermittent levosimendan therapy with serial NT-proBNP assessments. Clinical, echocardiographic, and laboratory data were collected before therapy initiation and after six months. Associations between ΔNT-proBNP and the defined outcomes were analyzed using logistic regression for all endpoints. Statistical significance was defined as p < 0.05.
Results
Among 59 patients (73% male), 65% had hypertension, 60% dyslipidemia, and 55% atrial fibrillation. Thirty-seven percent had an ICD, 27% a CRT-D, and 18% a CRT-P. Baseline left ventricular ejection fraction was 24.6% (IQR 19.5–29.5), and median NT-proBNP was 9,805 pg/mL (IQR 3,292–12,310). Before therapy, 97% of patients were in NYHA class III and median ΔNT-proBNP was 4069 pg/mL (IQR 2607-5030). NT-proBNP variation over six months did not show a significant association with any of the evaluated outcomes: for hospital readmissions (OR = 1.000, CI 95% [1.00, 1.00]; p = 0.13); Levosimendan reinitiation (OR = 1.000, CI 95% [1.00, 1.00]; p = 0.54); all-cause mortality (OR = 1.000, CI 95% [1.00, 1.00]; p = 0.79); and the composite outcome (OR = 1.000, CI 95% [1.00, 1.00]; p = 0.642).
Conclusions
In this cohort of patients with advanced HF treated with ILI, six-month NT-proBNP variation was not predictive of mortality, readmissions, therapy reinitiation, or the composite outcome. These results suggest that the evolution of NT-proBNP over time does not independently reflect medium-term clinical risk in this population. Therefore, ΔNT-proBNP should be interpreted in conjunction with other clinical and hemodynamic parameters rather than as an isolated prognostic marker. Larger prospective multicenter studies are warranted to further clarify the prognostic role of this biomarker in patients undergoing levosimendan therapy.