title: Diagnostic utility of contemporary echo and BNP assessment in patients with acute heart failure during early hospitalization.
abstract: BACKGROUND
  The use of B-type natriuretic peptide (BNP) and echocardiography in acute heart failure (AHF) diagnosis is poorly employed in the Emergency Department. The aim of the present study is to evaluate relation among BNP levels systolic and diastolic dysfunction during early phases of AHF hospitalization.
  
  
  METHODS
  We performed contemporary echocardiographic and BNP assessment in 310 patients with AHF within 12h since hospital admission. We studied the correlation among BNP and degree of diastolic dysfunction evaluated by pulsed Doppler transmitral flow and Tissue Doppler flow. Finally we investigated the relation among BNP and the right systolic longitudinal ventricular function (TAPSE) and the systolic pulmonary arterial pressure (PAPs).
  
  
  RESULTS
  BNP levels were 1417±1126, 1081±955, 894±901pg/mL, for patients with EF≤25%, EF 25-40% and EF 40-50% (p=0.005), respectively. "BNP levels linearly correlate with the degree of diastolic dysfunction: 582±406pg/mL in altered relaxation pattern, 712±557pg/mL in pseudonormal pattern and 1694±805 in restrictive filling pattern (p<0.001 for all patterns)." BNP levels were significantly increased in patients with right systolic ventricular dysfunction (TAPSE<18mm; p=0.006) and in patients with PAPs≥40mmHg (p=0.001). ROC curve and logistic regression analysis highlighted the power of BNP to detect severe systolic dysfunction, right ventricular (RV) overload and dysfunction and diastolic dysfunction patterns.
  
  
  CONCLUSIONS
  BNP levels correlate linearly with LV systolic dysfunction as well as with impaired degree of diastolic dysfunction. Significant PAP increase is a further factor influencing BNP elevation in patients with AHF during early hospitalization phase.
authors.affiliation: Cardiology Unit, Department of Internal Medicine, S. Maria alle Scotte Hospital Siena, University of Siena, Italy. Electronic address: palazzuoli2@unisi.it.
authors.forename: Alberto
authors.initials: A
authors.lastname: Palazzuoli
authors.affiliation: Cardiology Unit, Department of Internal Medicine, S. Maria alle Scotte Hospital Siena, University of Siena, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Beltrami
authors.affiliation: Cardiology Unit, Department of Internal Medicine, S. Maria alle Scotte Hospital Siena, University of Siena, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Ruocco
authors.affiliation: Cardiology Unit, Department of Internal Medicine, S. Maria alle Scotte Hospital Siena, University of Siena, Italy.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Franci
authors.affiliation: Cardiology Unit, Department of Internal Medicine, S. Maria alle Scotte Hospital Siena, University of Siena, Italy.
authors.forename: Maria Stella
authors.initials: MS
authors.lastname: Campagna
authors.affiliation: Cardiology Unit, Department of Internal Medicine, S. Maria alle Scotte Hospital Siena, University of Siena, Italy.
authors.forename: Ranuccio
authors.initials: R
authors.lastname: Nuti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000000981:diagnostic imaging*; D006760:Hospitalization; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D012372:ROC Curve; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*; D016277:Ventricular Function, Left
chemical_list: D020097:Natriuretic Peptide, Brain
keywords: Diastolic impairment; Echocardiography; Heart failure; Natriuretic peptides; Systolic dysfunction