Neurohumoral improvement and torsional dynamics in patients with heart failure after treatment with levosimendan

Abstract

BackgroundLevosimendan improves clinical and hemodynamic parameters exerting an anti-inflammatory and antiapoptotic effect in decompensated heart failure. The aim of this study was to evaluate the effects of levosimendan on LV torsion, plasma levels of NT-proBNP and on the balance between pro-inflammatory (TNF-α, IL-6) and anti-inflammatory cytokines (IL-10). MethodsWe enrolled 24 patients (age 62±7years) with acute HF, NYHA class IV and severe LV dysfunction. All patients underwent transthoracic echocardiography using two-dimensional speckle tracking analysis to detect LV twist angle (LVTA), at baseline and 1week after treatment with levosimendan infusion. Biochemical parameters (pro-BNP, IL-6, IL-10, TNF-α) were determined by enzyme-linked immunosorbent (ELISA). ResultsAfter one week, we observed an improvement in LV function especially in LVTA (4.15±2.54 vs 2.9±2.1 p<0.01), in LV ejection fraction (27.3±8.04 vs 21.6±6.8 p=0.03) and also a significant reduction in BNP levels (1844±560 vs 4713±1050, p=0.03). The multiple linear regression analysis showed a significant relation between a reduction of TNF α/IL-10 ratio (Δ>20%) and BNP (Δ>40%), LVEF (Δ>10%) and LVTA (Δ>20%) (O.R. 1.77, 95% C.I. 1.11–2.83; O.R. 1.49, 95% C.I. 1.08–2.67; O.R. 1.66, 95% C.I. 1.10–2.74, respectively, confirmed p, all <0.01 by Hosmer–Lemeshov confirmation and the formal test for interaction). ConclusionsLevosimendan exerts a hemodynamic effect by improving EF and LV torsion in patients with acute HF in association with a positive effect on the balance between pro and anti-inflammatory cytokines.