Time Course of B-Type Natriuretic Peptide (BNP) and N-Terminal ProBNP Changes in Patients with Decompensated Heart Failure

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Abstract
The short-term infusion of levosimendan (Simdax™), a calcium sensitizer, improves the hemodynamic function in patients with decompensated heart failure (1)(2)(3). Blood concentrations of B-type natriuretic peptide (BNP) and the amino-terminal fragment of its precursor hormone (NT-proBNP) have been reported to reflect the severity of heart failure (4), and BNP concentrations have been shown to decrease with improving hemodynamic function during tailored intravenous treatment of decompensated heart failure (5). Because of the shorter biological half-life of BNP compared with NT-proBNP (6), we hypothesized that BNP would show a faster response to hemodynamic improvement during intravenous levosimendan therapy. This could be of relevance considering the possible role of natriuretic peptides for guiding therapy in acutely decompensated heart failure. The present observational study, carried out prospectively at the Division of Internal Medicine, St. John of God Hospital (Linz, Austria), was approved by the local ethics committee in accordance to the Helsinki Declaration. Eligible patients were those admitted with acute decompensation of chronic heart failure who were judged to require hemodynamic monitoring and intravenous treatment. Inclusion criteria were defined as follows, based on a previous report (1): documented left ventricular ejection fraction ≤30% by echocardiogram and a pulmonary artery catheter placed for clinical purposes that demonstrated a pulmonary capillary wedge pressure (PCWP) ≥15 mmHg along with a cardiac index (CI) ≤2.5 L · min−1 · m−2. Exclusion criteria were angina-limited exercise; unstable angina or acute myocardial infarction with urgent need for invasive procedure; obstructive cardiomyopathy; uncorrected primary stenotic valve; history of ventricular flutter, fibrillation, …