Value of IGF-I levels in the evaluation of response to treatment with levosimendan in patients with severe heart failure

Objective: Levosimendan treatment has inotropic, anti-stunning, and cardioprotective effects in the setting of acute decompensated heart failure (HF). Among studies conducted on the treatment of heart failure, those based on the growth hormone axis are of particular interest. The aim of this study was to determine the value of baseline insulin-like growth factor 1 (IGF-I) measurements in predicting response to levosimendan treatment. Methods: The study population included patients on standard heart failure treatment who presented with functional capacity NYHA class 3-4 and left ventricular (LV) ejection fraction less than 35% were enrolled in this prospective, cohort study. Pre- and post-treatment symptoms of patients (72 hours after the completion of levosimendan infusion) and echocardiographic parameters were evaluated and blood samples were collected. Mann-Whitney U, Pearson Chi-square and Wilcoxon Sign Rank tests were used for statistical analysis. Correlations were determined using Spearman correlation analysis. Results: Thirty patients were enrolled in this study, 83.3% of whom were male and 16.7% were female, with a mean age of 62.6 ±10.1 years. Mean baseline IGF-I level was 106.9±47.0 μg/L. Statistically significant improvements were observed in NYHA class, mean brain natriuretic peptide (BNP) levels, LV ejection fraction and LV end-systolic volume values following treatment with levosimendan (respective pre-treatment and post-treatment values: 3.5±0.5 vs. 2.5±0.7, p 0.001; 1209.8±398.6 pg/ml vs. 704.1±344.6 pg/ml, p 0.001, and 25.7±6.6% vs. 29.0±6.8%, p=0.021, and 164.1±45.7 ml vs. 152.8±50.6 ml, p=0.012). Fourteen patients (46.7%) had low IGF-I levels, taking into consideration variations due to age and gender. Patients with normal baseline IGF-I values showed more significant decreases in BNP levels in response to treatment compared to those with low baseline IGF-I levels (650.5±367.2 pg/ml vs. 340.1±269.0 pg/ml, p=0.014). Conclusion: Baseline IGF-I levels may be used to predict response to levosimendan treatment in patients hospitalized for decompensated HF.