Non-invasive tissue Doppler imaging pulmonary capillary wedge pressure measurement improves NT-proBNP prognostic value in heart failure.
OBJECTIVE
The aim of the present study was to investigate whether the improvement of pulmonary capillary wedge pressure (PCWP) non-invasively assessed with tissue Doppler imaging is able to predict prognosis and cardiac-related mortality in patients with heart failure (HF), as previously demonstrated for NT-proBNP.


METHODS
We prospectively studied 23 patients (74 +/- 10 y; 17 M, 6 F) with acute HF. NT-proBNP and PCWP were measured at admission and discharge. NT-proBNP concentrations were determined by a chemiluminescent immunoassay kit. PCWP was assessed using the ratio of transmitral E velocity to the early diastolic mitral annulus velocity (E'), with the formula PCWP = 1.9 + 1.24 (E/E'). Patients were divided in two groups according to the clinical end-point based on cardiac death and hospital readmission for HF.


RESULTS
After a mean follow-up of 230 days, 10 patients reached the end-point (group A), while 13 patients resulted event-free (group B). In group B, NT-proBNP values significantly decreased (3816 +/- 7424 vs. 6799 +/- 10537 pg/mL, P < 0.01) and PCWP improved (17 +/- 7 vs. 23 +/- 12 mmHg, P < 0.01). The decrease in both NT-proBNP and PCWP values was able to identify the majority of patients (77%) with an event-free survival at follow-up, whereas 70% of patients who reached the end-point had discordant changes in NT-proBNP and PCWP (chi2 = 5.06, P < 0.05).


CONCLUSIONS
The combination of a biochemical marker such as NT-proBNP and a new indicator of LV filling pressure (E/E') allows to estimate the prognostic impact of standard medical therapy even in a small group of HF patients.
Berni
Andrea
A
Azienda Ospedaliero-Universitaria Careggi, Dipartimento di Area Critica Medico-Chirurgica, Università degli Studi di Firenze, Firenze, Italy. berniandrea@inwind.it
Cappelli
Francesco
F
Bitossi
Luca
L
Cecioni
Ilaria
I
Cappelli
Brunello
B
Toncelli
Loira
L
Galanti
Giorgio
G
Poggesi
Loredana
L
D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology*; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D007118:Immunoassay / Q000379:methods; D008163:Luminescent Measurements; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D012372:ROC Curve; D012720:Severity of Illness Index; D017725:Ventricular Pressure / Q000502:physiology*
D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain