Short-term outcomes of recombinant human brain natriuretic peptide added to levosimendan in patients with refractory heart failure: a single-center retrospective cohort study

To evaluate the short-term clinical outcomes of recombinant human brain natriuretic peptide (rhBNP) added to levosimendan in patients with refractory heart failure. This single-center retrospective cohort study included 100 patients with refractory heart failure who were hospitalized between January 2022 and June 2024. Patients were assigned according to the actual treatment regimen to either the combination group (levosimendan plus rhBNP) or the control group (levosimendan alone), with 50 patients in each group. Changes in cardiac function indices—left ventricular ejection fraction (LVEF), stroke volume (SV), cardiac output (CO), and cardiac index (CI)—and endothelial function markers—nitric oxide (NO) and endothelin-1 (ET-1)—were compared between groups before and after treatment. Adverse events were recorded and analyzed. Baseline characteristics were comparable between the two groups. After treatment, the overall response rate was 90.00% in the combination group, significantly higher than 74.00% in the control group ( P = 0.037). LVEF, SV, CO, and CI increased significantly from baseline in both groups, with greater improvements observed in the combination group (all P < 0.05). The increase in NO and the decrease in ET-1 were also more pronounced in the combination group than in the control group (both P < 0.05). The incidence of adverse events did not differ significantly between groups ( P > 0.05). In patients with refractory heart failure, rhBNP combined with levosimendan was associated with greater short-term improvements in cardiac function, vascular endothelial function, and overall treatment response than levosimendan alone, without a significant increase in observed adverse events. Further prospective studies with larger sample sizes and longer follow-up are needed to confirm these findings.