Guided therapy in patients with acute heart failure: left ventricular diastolic filling pattern and NT-proBNP

Yıl 2020, Cilt: 3 Sayı: 3, 285 - 290, 18.06.2020

Ersin Saricam , Arslan Ocal

https://doi.org/10.32322/jhsm.729105

Cited By: 1

Öz

Aim: N-terminal pro B-type natriuretic peptide has been commonly used in acute heart failure. We investigated whether the Doppler transmitral flow parameters on admission and discharge offer a useful guide like N-terminal pro B-type natriuretic peptide levels in acute heart failure.
Material and Method: This study with a prospective randomized design included 57 patients admitted to the emergency department between October 2019 and March 2020. All patients had New York Heart Association class IV, had sinus rhythm, and were diagnosed previously with dilate cardiomyopathy. The left ventricular diastolic filling pattern during admission and discharge was evaluated in all patients using transthoracic echocardiography. N-terminal pro B-type natriuretic peptide levels were analyzed on admission and discharge to compare the left ventricular filling pattern.
Results: The average age of the patients was 64.94±5.56 years. During admission, the left ventricular filling pattern of all patients was of restrictive type (type III), whereas during discharge, 46 patients had abnormal relaxation (type I) and 11 patients had pseudonormal (type II) filling pattern. N-terminal pro B-type natriuretic peptide levels were 8004.75±743 pg/mL and 1645.17±104.58 pg/mL during admission and discharge, respectively. The mean e/e’ ratio of the patients was 14.83±0.25 and 7.70±0.14 and E/A ratio was 2.51±0.35 and 1.42±0.33 during admission and discharge, respectively. N-terminal pro B-type natriuretic peptide levels with regard to the mitral filling pattern were different during discharge. The N-terminal pro B-type natriuretic peptide level with an abnormal relaxation pattern was 1440.43±144.75 pg/mL and that with a pseudonormal pattern was 1957.60±64.00 pg/mL (p=0.003).
Conclusion: Our study demonstrated that the left ventricular filling pattern successfully guided in acute heart failure therapy, similar to N-terminal pro B-type natriuretic peptide -guided therapy.

Anahtar Kelimeler

acute heart failure, left ventricular filling pattern, guided therapy

Akut kalp yetmezlikli hastalarda kılavuz tedavi: sol ventrikül doluş bulguları ve NT-proBNP

Öz

Amaç: N-terminal pro B tip natriüretik peptid akut kalp yetmezliğinde sıklıkla kullanılır. Bu çalışmada, akut kalp yetmezlikli hastaların Doppler transmitral akım parametrelerinin hastaneye kabul ve taburculukta N-terminal pro B tip natriüretik peptid gibi faydalı bir yaklaşım olup olamayacağını araştırdık.
Gereç ve Yöntem: Prospective randomize tasarlanan bu çalışma Ekim 2019-Mart 2020 arası acil bölümüne kabul edilen 57 hastaya kapsamaktadır. Tüm hastalar New York Heart Association sınıf IV olup sinüs ritminde ve önceden dilate kardiyomiyopati tanısı almışlardı. Hastalara giriş ve taburculukta transtorasik ekokardiyografi ile sol ventrikül diyastolik doluş paternleri değerlendirildi. Giriş ve çıkış N-terminal pro B tip natriüretik peptid seviyeleri sol venrtrikül doluş bulguları ile karşılaştırıldı.
Bulgular: Ortalama yaş 64,94±5,56 idi. Girişte tüm hastaların sol ventrikül doluş paternleri restriktif tip doluş bozukluğu idi. Taburculukta 46 hasta anormal relaksasyon bozukluğu (Tip I), 11 hasta pseudonormal doluş bozukluğu (Tip II) vardı. N-terminal pro B tip natriüretik peptid seviyeleri girişte 8004,75±743 pg/mL, taburculukta 1645,17±104,58 pg/mL idi. Ortalama e/e’ oranı girişte 14,83±0,25 taburculukta 7,70±0,14 idi. Ortalama E/A oranı girişte 2,51±0,35 taburculukta 1,42±0,33 idi. Anormal relaksasyon tipte N-terminal pro B tip natriüretikpeptidseviyeleri 1440,43±144,75 pg/mL, oysa pseudonormal pattern de N-terminal pro B tip natriüretik peptid seviyeleri 1957,60±64,00 pg/mL (p=0,003).
Sonuç: Akut kalp yetmezlikli hastalarda sol ventrikül doluş paternleri N-terminal pro B tip natriüretik peptid rehberliği gibi başarılı bir şekilde kullanılabileceğini göstermiştir.

Anahtar Kelimeler

Akut kalp yetmezliği, sol ventrikül doluş bulguları, kılavuz tedavi

Kaynakça

• 1. Ponikowski P, Voors AA, Anker SD, et al. Authors/task force members. 2016 European Society of Cardiology (ESC) guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the ESC developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 37: 2129-200.
• 2. Stevenson LW, Braunwald E. Recognition and management of patients with heart failure. In: Goldman L, Braunwald E, ed. Primary Cardiology. Philadelphia, PA: W.B. Saunders, 1998:310–29.
• 3. Maisel A. B-type natriuretic peptide measurements in diagnosing congestive heart failure in the dyspneic emergency department patient. Rev Cardiovasc Med 2002; 3: 10-7.
• 4. Maisel AS, Krishnaswamy P, Nowak RM, et al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 2002; 347:161-7.
• 5. Noveanu M, Breidthardt T, Potocki M, et al. Direct comparison of serial B-type natriuretic peptide and NT-proBNP levels for prediction of short-and long-term outcome in acute decompensated heart failure. J Crit Care 2011; 15: 1.
• 6. Stienen S, Salah K, Moons AH, et al. NT-proBNP-guided therapy in acute decompensated heart failure: the PRIMA II randomized controlled trial. Circulation 2018; 137: 1671-83.
• 7. Møller JE, Whalley GA, Dini FL, et al. Meta-Analysis Research Group in Echocardiography (MeRGE) AMI Collaborators. Independent prognostic importance of a restrictive left ventricular filling pattern after myocardial infarction: an individual patient meta-analysis: Meta-Analysis Research Group in Echocardiography acute myocardial infarction. Circulation 2008; 117: 2591-8.
• 8. Whalley GA, Doughty RN, Gamble GD, et al.Pseudonormal mitral filling pattern predicts hospital re-admission in patients with congestive heart failure. J Am Coll Cardiol 2002; 39: 1787-95.
• 9. Schiller NB, Shah PM, Crawford M, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on standards, subcommittee on quantitation of two-dimensional echocardiograms. J Am Soc Echocardiogr 1989; 2:358-67.
• 10. Nagueh SF, Smiseth OA, Appleton CP, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2016; 29:277–314.
• 11. Peverill RE. “Left ventricular filling pressure(s)”-ambiguous and misleading terminology, best abandoned. Int J Cardiol 2015; 191: 110-3.
• 12. Sharifov OF, Schiros CG, Aban I, Denney TS, Gupta H. Diagnostic accuracy of tissue doppler index e/e’ for evaluating left ventricular filling pressure and diastolic dysfunction/heart failure with preserved ejection fraction: a systematic review and meta-analysis. J Am Heart Assoc 2016; 5: e002530.
• 13. Balaney B, Medvedofsky D, Mediratta A, et al. Invasive validation of the echocardiographic assessment of left ventricular filling pressures using the 2016 diastolic guidelines: head-to-head comparison with the 2009 guidelines. J Am SocEchocardiogr 2018; 31: 79-88.
• 14. Rohde LE, Palombini DV, Polanczyk CA, Goldraich LA, Clausell N. A hemodynamically oriented echocardiography-based strategy in the treatment of congestive heart failure. J Card Fail 2007; 13: 618-25.
• 15. Felker GM, Anstrom KJ, Adams KF, et al. Effect of natriuretic peptide-guided therapy on hospitalization or cardiovascular mortality in high-risk patients with heart failure and reduced ejection fraction: a randomized clinical trial. JAMA 2017; 318: 713-20.
• 16. Ibrahim NE, Januzzi JL Jr. The future of biomarker-guided therapy for heart failure after the guiding evidence-based therapy using biomarker intensified treatment in heart failure (guide-it) study. Curr Heart Fail Rep 2018; 15: 37-43.
• 17. Pinamonti B, Zecchin M, Di Lenarda A, Gregori D, Sinagra G, Camerini F. Persistence of restrictive left ventricular filling pattern in dilated cardiomyopathy: an ominous prognostic sign. J Am Coll Cardiol 1997; 29: 604-12.