Role of B-type natriuretic peptide and echocardiographic indices in predicting the development of acute heart failure following beta-blocker uptitration in chronic heart failure patients with left ventricular systolic dysfunction.
We evaluated the role of clinical, BNP and echocardiographic left ventricular (LV) indices in predicting the development of acute heart failure (HF) following beta-blocker initiation and uptitration in 50 stable CHF patients with LVEF < 40% and creatininemia < 250 micromol/l. Use of NYHA class alone predicted the development of acute HF decompensation in only 56% and the absence of this event in 93% of patients. Use of echocardiographic indices (systolic PAP < 40 mmHg or E/A ratio < 1.4 or EDT > 145 ms) predicted the absence of acute HF decompensation in 100% of patients. Use of NYHA > 3 combined with BNP > 398 pg/ml or with echocardiographic indices (i.e. systolic PAP > 40 mmHg or E/A > 1.4 or EDT < 145 ms) predicted the development of acute HF decompensation in 100% of patients. In conclusion use of BNP and echocardiographic LV filling pressure indices in combination with NYHA class may predict beta-blocker tolerance more accurately than clinical indices alone in patients with LV systolic dysfunction (LVEF < 40%).
Ben Driss
Ahmed
A
Tabet
Jean-Yves
JY
Meurin
Philippe
P
Weber
Hélène
H
Renaud
Nathalie
N
Grosdemouge
Anne
A
Bourmayan
Claude
C
D000208:Acute Disease; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D002908:Chronic Disease; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010865:Pilot Projects; D011237:Predictive Value of Tests; D013599:Systole; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left
D000319:Adrenergic beta-Antagonists; D020097:Natriuretic Peptide, Brain