[B-type natriuretic peptide and Doppler echocardiography in the diagnosis of heart failure: alternative or complementary tools?].
Several studies have demonstrated the usefulness of B-type natriuretic peptide (BNP) dosage in patients referring for acute dyspnea in the emergency department. BNP is strongly associated not only with the evidence but even with the degree of heart failure, and BNP values are particularly increased in the advanced NYHA classes and in patients with poor prognosis. High BNP levels correlate with echocardiographic indexes of left ventricular and right ventricular systolic dysfunction but even better with diastolic dysfunction and degree of left ventricular filling pressure. However, in presence of some clinical confounders, such as obesity, renal insufficiency and anemia, BNP dosage itself cannot be interpretable. Under these circumstances, Doppler echocardiography is able to identify with better accuracy patients affected by heart failure. Algorithms built taking into account clinical and echocardiographic parameters as well as BNP measurements are already available in the guidelines of the European Society of Cardiology on heart failure with normal ejection fraction. They will lead to a better and earlier identification, better risk stratification and management of patients referring for heart failure.
Palazzuoli
Alberto
A
Dipartimento di Medicina Interna e Malattie Metaboliche, Università degli Studi A.O. S. Maria alle Scotte, Vale Bracci, 53100 Siena. palazzuoli2@unisi.it
Galderisi
Maurizio
M
Gallotta
Maddalena
M
Sciomer
Susanna
S
Nistri
Stefano
S
Agricola
Eustachio
E
Ballo
Piercarlo
P
Buralli
Simona
S
D'Andrea
Antonello
A
D'Errico
Arcangelo
A
Losi
Maria Angela
MA
Mele
Donato
D
Mondillo
Sergio
S
Nuti
Ranuccio
R
D015415:Biomarkers / Q000097:blood; D015150:Echocardiography, Doppler; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012720:Severity of Illness Index
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain