Levosimendan-induced reduction in natriuretic peptide levels during the treatment of decompensated heart failure: Clinical implications — Reply

Although, the potential use of natriuretic peptide testing in treatment monitoring of heart failure remains to be fully clarified, levosimendan-induced reduction in natriuretic peptide levels has consistently been reported to be associated with favorable clinical, hemodynamic, anti-inflammatory and anti-apoptotic effects. Several studies demonstrated that not only is plasma natriuretic peptide level important predictor of long-term outcomes, but changes in natriuretic peptide levels during the treatment of heart failure are also associated with corresponding changes in morbidity and mortality. Re-analysis of the data from our previously published study suggested a greater percentage of NT-proBNP reduction at 48 h in patients who survived compared to those who died in both levosimendan (− 36 ± 8% vs − 24 ± 13%, respectively) and dobutamine (− 32 ± 8% vs + 9 ± 32%, respectively) treatment groups, although not statistically different. The changes in natriuretic peptide levels during therapy reflect short-term hemodynamic improvements and effectiveness of drug regimens, but also may have a role in predicting long-term outcomes.