Combining echo and natriuretic peptides to guide heart failure care in the outpatient setting: A position paper

Dini, Frank Lloyd; Carluccio, Erberto; Montecucco, Fabrizio; Rosa, Gian Marco; Fontanive, Paolo

doi:10.1111/eci.12846

Cited by 13 publications

(8 citation statements)

References 66 publications

(87 reference statements)

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“…34 Thus, a position paper has recommended the use of BNP and LVFP in the management of HF patients in the ambulatory setting. 35 NT-proBNP also correlated strongly with indices of LVFP in a study of sixty-eight symptomatic patients with isolated diastolic dysfunction. 36 We also had a similar nding of positive correlation.…”

Section: Discussionmentioning

confidence: 86%

Diagnostic Value of NT-proBNP and Left Ventricular Filling Pressure in Chronic Kidney Disease (CKD) Patients with Acute Decompensated Heart Failure

Mansur¹,

Zartash²,

Rasool³

et al. 2021

Preprint

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BackgroundThe diagnosis of Acute Decompensated Heart Failure (ADHF) in Chronic Kidney Disease(CKD) patients is complex, NT-pro BNP interpretation in such a setting is complicated. The aim of this study is to determine the cutoff for NT-proBNP in CKD patients with ADHF. Methods: In this retrospective, cross-sectional study, 85 hospitalized patients were evaluated, 66 had CKD. All patients had clinical evidence of volume overload. NT-proBNP and eGFR were assessed in all patients. Left Ventricular Filling Pressure (LVFP) was measured to confirm the diagnosis of ADHF. Results: NT-proBNP was higher in volume overloaded patients with age more than 75 years as compared to those less than 75 years. NT-proBNP was higher in patients with CKD compared to non CKD patients. NT-proBNP progressively increased according to the CKD stage. The cutoff of NT- proBNP in patients with clinical evidence of volume overload and CKD was 1750 pg/ml and 2760 pg/ml in patients with high LVFP. In CKD patients with clinical volume overload and a high LVFP the NT-proBNP cutoff value was 3737pg/ml. There was a positive correlation of NT-BNP with LVFP and diastolic dysfunction. Conclusion: NT-proBNP has utility for the diagnosis of ADHF. It is higher in the CKD population and rises progressively with CKD stages. The cutoff for the diagnosis of ADHF in CKD patients is 3737 pg/ml in the setting of confirmed evidence of ADHF with a high LVFP.

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Section: Discussionmentioning

confidence: 86%

Diagnostic Value of NT-proBNP and Left Ventricular Filling Pressure in Chronic Kidney Disease (CKD) Patients with Acute Decompensated Heart Failure

Mansur¹,

Zartash²,

Rasool³

et al. 2021

Preprint

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“…In the last years, LUS has been proposed for the evaluation of pulmonary congestion, through the assessment of B-lines. Quantification of B-lines has been shown to be useful for the diagnosis, monitoring, and risk stratification of patients with known or suspected acute HF [ 27 ] and may add to the assessment of hemodynamic congestion by echo Doppler parameters and NPs also in an outpatient setting [ 12 , 28 ]. The echo Doppler estimation of LVFP by E / e ′ and NPs is somewhat correlated with pulmonary tissue water in large populations, but may provide different information in the single patient [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…Combining lung ultrasound (LUS) assessment of B-lines with EDT and E / e ′ may increase the diagnostic accuracy in estimating LVFP and in identifying pulmonary congestion [ 10 ]. Therefore, the combination of Doppler echocardiographic markers of LVFP, LUS, and NPs may be potentially valuable in guiding ambulatory HF management, since they can be useful in distinguishing stable patients from those at high risk of decompensation, optimizing treatment, reducing hospitalization, and consequently improving prognosis [ 11 , 12 ]. To investigate this concept, we compared the outcome of ambulatory patients with chronic HF and reduced or mildly reduced LV ejection fraction (EF) divided according to follow-up strategies: echo Doppler signs of elevated LVFP, LUS, and B-type natriuretic peptide (BNP)-directed follow-up (Group I); symptom-guided follow-up (Group II); and no organized follow-up for cardiovascular care (Group III).…”

Section: Introductionmentioning

confidence: 99%

Echo- and B-Type Natriuretic Peptide-Guided Follow-Up versus Symptom-Guided Follow-Up: Comparison of the Outcome in Ambulatory Heart Failure Patients

Bajraktari

Pugliese

D’Agostino

et al. 2018

Cardiology Research and Practice

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Recent European Society of Cardiology and American Heart Association/American College of Cardiology Guidelines did not recommend biomarker-guided therapy in the management of heart failure (HF) patients. Combination of echo- and B-type natriuretic peptide (BNP) may be an alternative approach in guiding ambulatory HF management. Our aim was to determine whether a therapy guided by echo markers of left ventricular filling pressure (LVFP), lung ultrasound (LUS) assessment of B-lines, and BNP improves outcomes of HF patients. Consecutive outpatients with LV ejection fraction (EF) ≤ 50% have been prospectively enrolled. In Group I (n=224), follow-up was guided by echo and BNP with the goal of achieving E-wave deceleration time (EDT) ≥ 150 ms, tissue Doppler index E/e′ < 13, B-line numbers < 15, and BNP ≤ 125 pg/ml or decrease >30%; in Group II (n=293), follow-up was clinically guided, while the remaining 277 patients (Group III) did not receive any dedicated follow-up. At 60 months, survival was 88% in Group I compared to 75% in Group II and 54% in Group III (χ2 53.5; p < 0.0001). Survival curves exhibited statistically significant differences using Mantel–Cox analysis. The number needed to treat to spare one death was 7.9 (Group I versus Group II) and 3.8 (Group I versus Group III). At multivariate Cox regression analyses, major predictors of all-cause mortality were follow-up E/e′ (HR: 1.05; p=0.0038) and BNP >125 pg/ml or decrease ≤30% (HR: 4.90; p=0.0054), while BNP > 125 pg/ml or decrease ≤30% and B-line numbers ≥15 were associated with the combined end point of death and HF hospitalization. Evidence-based HF treatment guided by serum biomarkers and ultrasound with the goal of reducing elevated BNP and LVFP, and resolving pulmonary congestion was associated with better clinical outcomes and can be valuable in guiding ambulatory HF management.

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“…There is serious concern about the strict resemblance of NP predictive values among patients with HFrEF/HFmrEF to those with HFpEF [37]. The DIAST-CHF trial revealed that NT-proBNP was a better predictor of incident atrial fibrillation than HF among stable outpatients with CV risk factors [38].…”

Section: Biomarkers Of Myocardial Stretch and Biomechanical Stressmentioning

confidence: 99%

Biomarkers in Heart Failure: From Research to Clinical Practice

Berezin

2022

Ann Lab Med

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The aim of this narrative review is to summarize contemporary evidence on the use of circulating cardiac biomarkers of heart failure (HF) and to identify a promising biomarker model for clinical use in personalized point-of-care HF management. We discuss the reported biomarkers of HF classified into clusters, including myocardial stretch and biomechanical stress; cardiac myocyte injury; systemic, adipocyte tissue, and microvascular inflammation; cardiac fibrosis and matrix remodeling; neurohumoral activation and oxidative stress; impaired endothelial function and integrity; and renal and skeletal muscle dysfunction. We focus on the benefits and drawbacks of biomarker-guided assistance in daily clinical management of patients with HF. In addition, we provide clear information on the role of alternative biomarkers and future directions with the aim of improving the predictive ability and reproducibility of multiple biomarker models and advancing genomic, transcriptomic, proteomic, and metabolomic evaluations.

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Combining echo and natriuretic peptides to guide heart failure care in the outpatient setting: A position paper

Abstract: Background: Chronic heart failure (HF) is a relevant and growing public health

Cited by 13 publications

References 66 publications

Diagnostic Value of NT-proBNP and Left Ventricular Filling Pressure in Chronic Kidney Disease (CKD) Patients with Acute Decompensated Heart Failure

Diagnostic Value of NT-proBNP and Left Ventricular Filling Pressure in Chronic Kidney Disease (CKD) Patients with Acute Decompensated Heart Failure

Echo- and B-Type Natriuretic Peptide-Guided Follow-Up versus Symptom-Guided Follow-Up: Comparison of the Outcome in Ambulatory Heart Failure Patients

Biomarkers in Heart Failure: From Research to Clinical Practice

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