Can Brain Natriuretic Peptide Be Used to Guide the Management of Patients With Heart Failure and a Preserved Ejection Fraction?

Packer, Milton

doi:10.1161/circheartfailure.111.963710

Cited by 38 publications

(34 citation statements)

References 21 publications

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“…Moreover, no study has reliably established a threshold level of BNP or N-terminal pro-BNP (NT-proBNP) that is diagnostic of the presence of heart failure in patients with the above comorbidities. Nevertheless, it is generally agreed that the higher the levels of BNP or NT-proBNP, the more likely the exertional breathlessness or fatigue can be attributed to heart failure rather than associated comorbidities [39]. Also, when a HFpEF diagnosis requires an elevated NT-proBNP, the outcome is much worse (compared with when an elevated NTproBNP is not used) and a survival similar to that of HFrEF is observed [40 && ].…”

Section: Role Of Exercise Testing and Invasive Evaluationmentioning

confidence: 99%

Heart failure with preserved ejection fraction

Liu

Haddad²,

Dwivedi³

2013

Current Opinion in Cardiology

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Section: Role Of Exercise Testing and Invasive Evaluationmentioning

confidence: 99%

Heart failure with preserved ejection fraction

Liu

Haddad²,

Dwivedi³

2013

Current Opinion in Cardiology

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“…In the general population, approximately half of the patients with HF have a preserved left ventricular (LV) ejection fraction (HFpEF) and abnormal LV diastolic function, as evidenced by invasive hemodynamic assessment, Doppler echocardiography or elevated natriuretic peptides levels. On the other hand, recent studies have suggested that several non-diastolic abnormalities in cardiovascular function might play a role in the pathophysiology of HFpEF, and also give rise to the speculation that HFpEF does not represent a specific disease entity, but rather merely describes elderly breathless patients with multiple co-morbidities [5].…”

Section: Introductionmentioning

confidence: 99%

Prognostic implications of heart failure with preserved ejection fraction in patients with an exacerbation of chronic obstructive pulmonary disease

et al. 2015

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Diagnosing heart failure with preserved ejection fraction (HFpEF) in patients with chronic obstructive pulmonary disease (COPD) is difficult due to overlapping pathophysiological pathways, risk factors and clinical presentations. We investigated the prevalence and prognostic implications of coexisting HFpEF in patients hospitalized for acute exacerbation of COPD. A total of 116 consecutive patients with an acute exacerbation of COPD were evaluated for HFpEF and followed for an average period of 22 ± 9 months for the occurrence of death from any cause. HFpEF was diagnosed in 22 (19 %) patients with COPD, who were older, and also had higher LV mass, left atrial size, and mitral E/Ea ratio than those without HFpEF (p < 0.05 for all comparisons). HFpEF was not independently associated with all-cause mortality [hazard ratio (HR) 1.07, 95 % confidence interval (CI) 0.44-2.62]. Global initiative for chronic Obstructive Lung Disease (GOLD) stage (IV vs. I-III, HR 2.37, CI 1.23-4.59) and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels (HR 2.79, CI 1.12-6.98) were independent predictors of long-term survival. HFpEF is present in one-fifth of patients with exacerbated COPD. Non-invasively diagnosed HFpEF may not be an independent predictor of all-cause mortality. Elevated NT-proBNP levels and very severe COPD were independently associated with unfavorable overall survival.

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“…20 Secondly, is HFPEF a distinct disease entity, or does it merely represent a collection of co-morbidities in an elderly breathless patient? 21 The potential for misdiagnosis of HFPEF is clinically relevant and an important consideration particularly in earlier trials such as CHARMPreserved, where patients were enrolled solely on the basis of symptoms and signs of heart failure (and normal EF), with or without a history of recent heart failure hospitalization, and in the absence of additional echocardiographic or biomarker criteria. 10 In fact, Caruana et al 20 showed that alternative non-heart failure diagnoses were available that could explain patients' symptoms and signs in the majority of cases in their cohort of suspected HFPEF from general practice.…”

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confidence: 99%

How do patients with heart failure with preserved ejection fraction die?

Chan

Lam

2013

European J of Heart Fail

187

148

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Understanding how patients with heart failure with preserved ejection fraction (HFPEF) die provides insight into the natural history and pathophysiology of this complex syndrome, thereby allowing better prediction of response to therapy in designing clinical trials. This review summarizes the current state of knowledge surrounding mortality rates, modes of death, and prognostic factors in HFPEF. Despite the lack of uniform reporting, the following conclusions may be drawn from previous studies. The mortality burden of HFPEF is substantial, ranging from 10% to 30% annually, and higher in epidemiological studies than in clinical trials. Mortality rates compared with heart failure with reduced ejection fraction (HFREF) appear to be strongly influenced by the type of study, but are clearly elevated compared with age-and co-morbidity-matched controls without heart failure. The majority of deaths in HFPEF are cardiovascular deaths, comprising 51-60% of deaths in epidemiological studies and 70% in clinical trials. Among cardiovascular deaths, sudden death and heart failure death are the leading cardiac modes of death in HFPEF clinical trials. Compared with HFREF, the proportions of cardiovascular deaths, sudden death, and heart failure deaths are lower in HFPEF. Conversely, non-cardiovascular deaths constitute a higher proportion of deaths in HFPEF than in HFREF, particularly in epidemiological studies, where this difference may be related to fewer coronary heart deaths in HFPEF. Key mortality risk factors, including age, gender, body mass index, burden of co-morbidities, and coronary artery disease, offer some explanation for the differences in mortality rates observed across studies.--

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Can Brain Natriuretic Peptide Be Used to Guide the Management of Patients With Heart Failure and a Preserved Ejection Fraction?

Cited by 38 publications

References 21 publications

Heart failure with preserved ejection fraction

Heart failure with preserved ejection fraction

Prognostic implications of heart failure with preserved ejection fraction in patients with an exacerbation of chronic obstructive pulmonary disease

How do patients with heart failure with preserved ejection fraction die?

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