Effect of levosimendan combined with recombinant human brain natriuretic peptide on diuretic resistance

Figures & data

Box 1. Scoring criteria of dyspnea

Evaluation conditions	Five-point Likert scale score for dyspnea
At least 2 L/min of oxygen inhalation through nasal catheter in sitting position at >60° Evaluation after 3 minutes of balance If there is mild or no dyspnea, go to the next step	Heaviest dyspnea 1 Severe dyspnea 2 Moderate dyspnea 3 Mild dyspnea 4 No dyspnea 5
Do not inhale oxygen when sitting at position >60° Evaluation after 3 minutes of balance If there is mild or no dyspnea, go to the next step	Most severe dyspnea 6 Severe dyspnea 7 Moderate dyspnea 8 Mild dyspnea 9 No dyspnea 10
Supine head elevation at <20° without oxygen inhalation Evaluation after 3 minutes of balance If there is mild or no dyspnea, go to the next step	Heaviest dyspnea 11 Severe dyspnea 12 Moderate dyspnea 13 Mild dyspnea 14 No dyspnea 15
Evaluation after walking for 50 m If there is mild or no dyspnea, go to the next step	Most severe dyspnea 16 Severe dyspnea Moderate dyspnea 18 Mild dyspnea 19 No dyspnea 20
6-Minute walk test	Most severe dyspnea 21 Severe dyspnea 22 Moderate dyspnea 23 Mild dyspnea 24 No dyspnea 25

This scale is based on the recommendations of the European Society of Cardiology International Working Group on acute heart failure [30].

Table 1. Demographics and baseline characteristics of patients

Parameters	Control group (n = 64)	Treatment group (n = 64)	P-Value
Sex (n [%]): male	34 (53.1)	40 (62.5)	0.08
Age (years; mean ± SD)	58.60 ± 9.60	57.70 ± 10.40	0.61
Course of disease (years; mean ± SD)	4.40 ± 1.70	3.9 ± 1.90	0.12
Weight (kg; mean ± SD)	75.30 ± 9.20	76.70 ± 11.20	0.45
ACE/ARB	60 (93.8)	57 (89.1)	0.16
Beta-blockers	59 (92.2)	62 (96.9)	0.16
Aldosterone receptor antagonists	58 (90.6)	61 (95.3)	0.16
NYHA cardiac function class (n [%]) Class III Class IV	25 (39.1) 39 (60.9)	27 (42.2) 37 (57.8)	0.13
EF (%; n [%]) 30–40 15-30	46 (71.9) 18 (28.1)	42 (65.6) 22 (34.4)	0.11
eGFR (mL/min/1.73 m^2; n [%]) ≥45 30–45	56 (87.5) 8 (12.5)	54 (84.4) 10 (15.6)	0.18
Combined diseases (n [%]) Dilated heart disease Coronary heart disease Rheumatic heart disease Atrial fibrillation Arterial-hypertension	24 (37.5) 29 (45.3) 2 (3.1) 8 (12.5) 16 (25)	20 (31.3) 24 (37.5) 2 (3.1) 12 (18.8) 19 (29.7)	0.11 0.10 0.5 0.12 0.13

ACE = angiotensin-converting enzyme; ARB = angiotensin II receptor blocker; EF = ejection fraction; eGFR = estimated glomerular filtration rate; NYHA = New York Heart Association.

Figure 1. Patients’ flowchart

rhBNP: recombinant human brain natriuretic peptide.

Table 2. Comparison of efficacy outcomes between the 2 groups

Index	Control group (n = 64)		Treatment group (n = 64)
	Before treatment	After treatment	Before treatment	After treatment
Urine volume (mL)	751 ± 128	1250 ± 116^a	782 ± 112	1950 ± 124^ab
Weight (kg)	75.30 ± 9.20	74.9 ± 10.7	76.70 ± 11.20	73.5 ± 5.7^ab
Dyspnea score	2.84 ± 1.58	4.37 ± 2.15^a	2.75 ± 1.68	6.38 ± 2.27^ab

Data were mean ± standard deviation.

Before treatment vs. after treatment for the same group^{: a}P<.05.

Control group vs. treatment group for the same time: ^bP<.05.

Table 3. Comparison of safety indexes between the 2 groups before and after treatment

Index	Control group (n = 64)		Treatment group (n = 64)
	Before treatment	After treatment	Before treatment	After treatment
Systolic blood pressure (mmHg)	123.2 ± 11.4	121.8 ± 13.9	124.4 ± 14.2	121.9 ± 19.3
Heart rate (beats/min)	76 ± 18	81 ± 14	79 ± 15	74 ± 18
Serum creatinine (μmol/L)	83.43 ± 17.74	86.43 ± 16.59	81.45 ± 19.87	78.75 ± 20.47

Data were mean ± standard deviation.

Before treatment vs. after treatment for the same group^: P > .05.

Data availability statement

All data used in this study will be available from the corresponding author upon reasonable request.