Effect Of Recombinant Human Brain Natriuretic Peptide Followed By Levosimendan On Patients With Refractory Heart Failure

Objective: To investigate the clinical effect of recombinant human brain natriuretic peptide(rhBNP)followed by levosimendan on patients with refractory heart failure(RHF).Methods: 40 patients with RHF who received hospitalized treatment in the Department of Cardiology of the Second hospital of Hebei medical university from August 2019 to January 2020 were enrolled and divided into sequential group and rhBNP group by random number table method,which were denoted as group A and group B,with 20 cases in each group.Patients in both groups were given conventional treatment such as diuretics,digitalis and Angiotensin converting enzyme inhibitor(ACEI)/Angiotensin receptor blocker(ARB)after admission.On the basis of conventional treatment,group A receied rhBNP at a loading dose of 1.5μg/kg followed by a continuous infusion of 0.0075-0.015μg/kg/min for 72 hours and then sequenced levosimendan at a loading dose of 6μg/kg(infused about 10 min)followed by a continuous infusion of 0.05-0.2μg/kg/min for 24 hours.On the basis of conventional treatment,group B also receied rhBNP treatment for 72 hours,with the same method and dose as group A,and then accepted conventional treatment.The infusion rate of the two groups was adjusted according to blood pressure and heart rate(HR)during the administration.N-terminal pro-brain natriuretic peptide(NT-proBNP),left ventricular ejection fraction(LVEF),stroke volume(SV),left ventricular end-diastolic diameter(LVEDD),6 minutes walking distance(6MWD),daily net output,serum creatinine(Scr)and cardiac function class of NYHA were observed before and 1 week after treatment.The adverse reactions of the two groups during medication were observed and the major adverse cardiac events(MACE)were followed up within 30 days.Result: There was no statistically significant differences in baseline data and various observation indicators between the two groups before medication(P>0.05).One week after treatment,the level of NT-proBNP,LVEF,SV,LVEDD,6MWD,daily net output and Scr were all improved in both groups compared with baseline levels.One week after treatment,the improvement of NT-proBNP,LVEF,SV,6MWD and daily net output in group A were higher than that in group B,and the difference was statistically significant(P<0.05).Compared with group B,the effective rate in group A was higher and the difference was statistically significant(P<0.05).There was no significant difference between the two groups in the rate of incidence of adverse reactions during medication and the MACE within 30 days(P>0.05).Conclusion: 1.The treatment of rhBNP followed by levosimendan can effectively reduce the concentration of NT-proBNP and increase the level of LVEF,SV,6MWD and daily net output,significantly improve the cardiac function and quality of life in patients with RHF.2.The treatment of rhBNP followed by levosimendan has little effect on Scr and does not increase the risk of incidence of adverse reactions and MACE within 30 days,with good security.