Abstract
Abstract Funding Acknowledgements Type of funding sources: None. Introduction NT-proBNP is a cardiac biomarker with diagnostic and prognostic value. Assessment of NT-proBNP enables to determine, or exclude, cardiac cause of dyspnea, and variations in its levels are significantly related with prognosis, as higher values in heart failure have a significantly worse prognosis than those with reduction of its value. Acute heart failure might be associated with acute coronary syndromes (ACS) and may require inotropic therapy to improve hemodynamic status and optimize cardiac output. Inotropes help improve cardiac contractility, therefore, increase stroke volume, cardiac output, and meliorating heart failure congestive or low perfusion symptoms and NT-proBNP value. Purpose This study aims to evaluate the effect of the use of Inotropes on the NT-proBNP value, comparing Levosimendan with Dobutamine, in patients hospitalized for acute heart failure associated with ACS. Methods We analyzed a retrospective, multicenter, observational cohort of 150 patients, admitted for ACS, with Killip 3 or 4 at presentation, requiring inotropic therapy. The population was divided into two groups: a group that used Levosimendan and a second group that used Dobutamine. The mean value of NT-proBNP, during hospitalization, was compared between both groups and compared with placebo. Results Levosimendan sample included 75 patients, of which 35,0% (n=26) were women, with a mean age of 82 ± 14.5 years old, while Dobutamine sample had 75 elements, of which 38% (n=28) were women with a mean age of 81.8 ± 12.9 years old. There was no statistically significant difference between both samples on age and sex distribution. Levosimendan group had a mean NT-proBNP value of 8870±100 pg/mL, while Dobutamine group had a mean mean NT-proBNP value of 12454±984 pg/mL. There was no statically difference on mean NT-proBNP value comparing both inotropic therapy samples (p>0,05), however, there was a statistically significant difference, with a higher decrease in mean NT-proBNP value, in patients using Levosimendan, comparing with not using inotropes (1382 pg/mL vs 12329 pg/mL, p<0,01), not verified, with a not statistically significant difference comparing Dobutamine and no inotropic therapy. Conclusion Levosimendan is associated with a higher decrease in NT-proBNP value. As heart failure might complicate ACS episode, and might require inotropic therapy, we should be aware that the choice of using Levosimendan in these situations may confer a greater analytic benefit, associated with the higher decrease in NT-proBNP value, which might be associated with a better prognostic value. However, treatment guided by value of NT-proBNP is yet to be validaded.
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