This study assessed the relation between B-type natriuretic peptide(BNP) and echocardiographic indexes of left ventricular(LV) filling pressure in 53 patients with stable heart failure and without significant valvular...This study assessed the relation between B-type natriuretic peptide(BNP) and echocardiographic indexes of left ventricular(LV) filling pressure in 53 patients with stable heart failure and without significant valvular dysfunction. Left atrial volume indexed to body surface area(LAVi), an indicator of chronic LV filling pressure, was correlated with BNP(r=0.692, p< 0.001) and was the strongest independent predictor of elevated levels in this cohort. LAVi was also the best predictor of BNP ≥100 pg/ml, with an area under the receiver-operating characteristic curve of 0.85(95%confidence interval 0.74 to 0.96, p< 0.001). Using the optimal cutoff of >31 ml/m2, LAVi had a sensitivity of 92%and a specificity of 65%for BNP ≥100 pg/ml. Patients with LAVi >31 ml/m2 had a median BNP of 122 pg/ml, compared with 21 pg/ml in patients with LAVi ≤31 ml/m2(p< 0.001). These findings suggest that in patients with stable heart failure, BNP levels are related to chronic LV filling pressures. This may help explain the relatively modest correlation between BNP and acute measures of LV filling and the heterogeneity in BNP levels in patients with stable heart failure.展开更多
Background: We sought to assess the utility of serial BNP measurements in patients with severe heart failure and attempted to correlate values with invasively derived data. Methods: In a retrospective study, we analyz...Background: We sought to assess the utility of serial BNP measurements in patients with severe heart failure and attempted to correlate values with invasively derived data. Methods: In a retrospective study, we analyzed serial BNP levels in patients receiving hemodynamically guided therapy for severe heart failure and sought correlationwith invasively derived data. Results: Thirty-nine patients with New York Heart Association Class III-IV, with an ejection fraction of 35%or less, who had a pulmonary artery catheter inserted for hemodynamically tailored heart failure therapy, were identified and serial BNP measurements reviewed. BNP was estimated on admission, at 12 and 36 hours. Normally distributed variables are expressed as mean±SD and otherwise as median±interquartile range. Mean ejection fraction was 16%±6%. Mean pulmonary artery occlusion pressures(PAOP) fell with therapy and were 25±7 mmHg, 18±7mmHg and 19±7mmHg at admission, 12 hours and 36 hours respectively(P< 0.05). Median BNP levels fell from 1200±641 to 771±803 at 12 hours and to 805±771 at 36 hours(P< . 001). There was no correlation between BNP and any hemodynamically derived variable. A change in BNP was not associated with a change in PAOP in any individual patient. Only 42%remained alive on medical therapy at 30 days. Conclusions: In patients with severe heart failure, BNP levels do not accurately predict serial hemodynamic changes and do not obviate the need for pulmonary artery catheterization.展开更多
文摘This study assessed the relation between B-type natriuretic peptide(BNP) and echocardiographic indexes of left ventricular(LV) filling pressure in 53 patients with stable heart failure and without significant valvular dysfunction. Left atrial volume indexed to body surface area(LAVi), an indicator of chronic LV filling pressure, was correlated with BNP(r=0.692, p< 0.001) and was the strongest independent predictor of elevated levels in this cohort. LAVi was also the best predictor of BNP ≥100 pg/ml, with an area under the receiver-operating characteristic curve of 0.85(95%confidence interval 0.74 to 0.96, p< 0.001). Using the optimal cutoff of >31 ml/m2, LAVi had a sensitivity of 92%and a specificity of 65%for BNP ≥100 pg/ml. Patients with LAVi >31 ml/m2 had a median BNP of 122 pg/ml, compared with 21 pg/ml in patients with LAVi ≤31 ml/m2(p< 0.001). These findings suggest that in patients with stable heart failure, BNP levels are related to chronic LV filling pressures. This may help explain the relatively modest correlation between BNP and acute measures of LV filling and the heterogeneity in BNP levels in patients with stable heart failure.
文摘Background: We sought to assess the utility of serial BNP measurements in patients with severe heart failure and attempted to correlate values with invasively derived data. Methods: In a retrospective study, we analyzed serial BNP levels in patients receiving hemodynamically guided therapy for severe heart failure and sought correlationwith invasively derived data. Results: Thirty-nine patients with New York Heart Association Class III-IV, with an ejection fraction of 35%or less, who had a pulmonary artery catheter inserted for hemodynamically tailored heart failure therapy, were identified and serial BNP measurements reviewed. BNP was estimated on admission, at 12 and 36 hours. Normally distributed variables are expressed as mean±SD and otherwise as median±interquartile range. Mean ejection fraction was 16%±6%. Mean pulmonary artery occlusion pressures(PAOP) fell with therapy and were 25±7 mmHg, 18±7mmHg and 19±7mmHg at admission, 12 hours and 36 hours respectively(P< 0.05). Median BNP levels fell from 1200±641 to 771±803 at 12 hours and to 805±771 at 36 hours(P< . 001). There was no correlation between BNP and any hemodynamically derived variable. A change in BNP was not associated with a change in PAOP in any individual patient. Only 42%remained alive on medical therapy at 30 days. Conclusions: In patients with severe heart failure, BNP levels do not accurately predict serial hemodynamic changes and do not obviate the need for pulmonary artery catheterization.
