Surfactant proteins changes after acute hemodynamic improvement in patients with advanced chronic heart failure treated with Levosimendan

Background: Alveolar-capillary membrane diffusion evaluated by carbon monoxide diffusion (DLCO) plays an important role in heart failure (HF). Cardiopulmonary exercise test (CPET) is a powerful diagnostic and prognostic tool in this context. Surfactant Proteins (SPs) have also been suggested as a worthwhile marker in these patients. In HF, Levosimendan improves cardiopulmonary hemodynamics and reduces lung fluids but associated SPs and DLCO changes are unknown. Purpose: To show changes in serum SPs values and in CPET parameters after Levosimendan administration in patients with advanced HF. Methods: Sixty-five advanced HF patients (NYHA class III/IV, VO2 = 12 underwent complete spirometry, CPET and SPs determination before and after Levosimendan infusion. Results: Levosimendan caused a significant natriuretic peptide-B (BNP) reduction (from 954 to 370 ng/ml*), peakVO2 increase (from 10.1±2.4 to 11.5±2.3 mL/kg/min*) and VE/VCO2 slope reduction (from 42±10 to 36±7*) (* = p < 0.01, Tab.1). FEV1, FVC and alveolar volume increased but DLCO did not. SP-A, SP-D and immature SP-B reduced while mature SP-B increased (Fig.1). Spirometry, BNP and CPET changes suggest an hemodynamic improvement and lung fluid reduction after inotropic drug infusion. In parallel SP-A, SP-D and immature SP-B reduction indicates an alveolar-capillary membrane hemodynamic and general inflammatory stress reduction. Conversely, mature SP-B increase suggests an alveolar cell function restoration. Conclusions: Levosimendan improves VO2 peak, decreases VE/VCO2 slope and decreases plasma levels of BNP. Hemodynamic improvement and acute lung fluid reduction is associated with SPs but not DLCO changes. SPs are fast responders to alveolar-capillary membrane condition changes.