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

Background: Levosimendan 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-alpha, IL-6) and anti-inflammatory cytokines (IL-10).Methods: We enrolled 24 patients (age 62 +/- 7 years) 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 1 week after treatment with levosimendan infusion. Biochemical parameters (pro-BNP, IL-6, IL-10, TNF-alpha) were determined by enzyme-linked immunosorbent (ELISA).Results: After oneweek, we observed an improvement in LV function especially in LVTA (4.15 +/- 2.54 vs 2.9 +/- 2.1 p b 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 alpha/ IL-10 ratio (Delta > 20%) and BNP (Delta > 40%), LVEF (Delta > 10%) and LVTA (Delta > 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 b0.01 by Hosmer-Lemeshov confirmation and the formal test for interaction).Conclusions: Levosimendan 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. (C) 2014 Published by Elsevier Ireland Ltd. This is an open access article under the CC BY-NC-ND license