title: Clinical value of B-type natriuretic peptide for the assessment of left ventricular filling pressures in patients with systolic heart failure and inconclusive tissue Doppler indexes.
abstract: Invasive hemodynamic monitoring with Swan-Ganz catheterization to guide treatment decisions in heart failure may be hazardous and may lack prognostic value. We assessed the clinical utility of B-type natriuretic peptide (BNP) in estimating left ventricular filling pressures in patients with inconclusive tissue Doppler indexes. In this study, 50 patients with systolic heart failure and an early transmitral velocity to early diastolic mitral annular velocity ratio (E/Ea) between 8 and 15 were studied. Among them, 25 had been admitted for acutely decompensated heart failure (group A) and the remainder were clinically stable outpatients (group B). All patients underwent simultaneous invasive pulmonary capillary wedge pressure (PCWP) determination, BNP measurement, and echocardiography. In group A, BNP correlated with PCWP (r = 0.803, P < 0.001), deceleration time (DT, r = -0.602, p = 0.001), and end-systolic wall stress (SWS, r = 0.565, P = 0.003). In multivariate analysis, BNP was the only parameter independently associated with PCWP (P = 0.023). In group B, no correlation was found between BNP and PCWP or SWS, while DT correlated significantly with both PCWP (r = -0.817, P < 0.001) and BNP (r = -0.8, P < 0.001). We conclude that BNP may be a useful noninvasive tool for the assessment of left ventricular filling pressures in patients with acutely decompensated heart failure and inconclusive tissue Doppler indexes.
authors.affiliation: Department of Cardiology, Athens General Hospital, Achilleos 31, Athens, Greece.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Karavidas
authors.forename: George
authors.initials: G
authors.lastname: Lazaros
authors.forename: Evangelos
authors.initials: E
authors.lastname: Matsakas
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Farmakis
authors.forename: John
authors.initials: J
authors.lastname: Parissis
authors.forename: Ioannis A
authors.initials: IA
authors.lastname: Paraskevaidis
authors.forename: Christos
authors.initials: C
authors.lastname: Michailidis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Avramidis
authors.forename: Achilleas
authors.initials: A
authors.lastname: Zacharoulis
authors.forename: Sophia
authors.initials: S
authors.lastname: Arapi
authors.forename: Andreas
authors.initials: A
authors.lastname: Kaoukis
authors.forename: Apostolos
authors.initials: A
authors.lastname: Zacharoulis
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D015150:Echocardiography, Doppler; D005260:Female; D054143:Heart Failure, Systolic / Q000097:blood* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D011669:Pulmonary Wedge Pressure; D016277:Ventricular Function, Left; D017725:Ventricular Pressure
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain