Repeated Administiration of Levosimendan/Furosemide Infusion on NT-Pro-BNP Levels in Advanced Heart Failure

Levosimendan is a calcium sensitizer used for managing heart failure (HF) because of its inotropic and vasodilatory effects. Our objective was to analyze the feasibility and effectiveness of levosimendan infusion in hospitalized advanced-stage HF patients with acute decompensation and compare it with furosemide. A total of 227 patients with left ventricular ejection fraction (LVEF) < 40% were enrolled, including 116 receiving levosimendan/furosemide and 111 receiving furosemide. Demographic and laboratory parameters; age, sex, creatinine, estimated glomerular filtration rate (eGFR), and NT-proBNP levels were assessed in both groups at weeks 1, 3, and 9. Sodium, calcium, and uric acid levels were additionally compared at weeks 1 and 9. Both levosimendan/furosemide and furosemide groups showed a significant reduction in NT-pro-BNP levels over the 9-week follow-up (p < 0.001). However, the furosemide group exhibited a significant increase in creatinine and uric acide (p < 0.001). In patients receiving levosimendan/furosemide, LVEF values negatively influenced NT-pro-BNP levels across all quantiles, with this effect being particularly stronger at higher NT-proBNP levels (B = − 432.09, p < 0.05; B = − 722.12, p < 0.001; B = − 833.68, p < 0.001), whereas furosemide was effective only in the high NT-pro-BNP subgroup (B = − 1128.26, p < 0.05). When the patients were divided into 3 groups according to their NT-pro-BNP levels, the effect of the drug was detected at all levels in the levosimendan/furosemide group. The findings demonstrated that levosimendan-treated patients with advanced HFrEF exhibited significantly reduced NT-proBNP levels relative to those receiving furosemide. As a result, we concluded that levosimendan had fewer side effects and was more useful.