Kalp Yetersizliğinde B-çizgileri ile NT-ProBNP Düzeyleri Arasında Güçlü ve Direkt Korelasyon
Year 2021,
Volume: 43 Issue: 6, 640 - 647, 24.09.2021
Hakan Dolgun
,
Nurdan Acar
,
Engin Özakın
,
Filiz Kaya
,
Mustafa Emin Çanakçı
,
Ebubekir Arslan
,
Turgay Çağlayan
Abstract
Çalışmanın amacı, odaklanmış akciğer ultrasonu üzerindeki B-çizgilerinin sayısının, New York Kalp Derneği'nin (NYHA) klinik kalp yetmezliği sınıflaması ve acil serviste NT-proBNP düzeyleriyle ilişkisini değerlendirmekti. Bu ileriye dönük çalışma, bir üçüncü basamak üniversite hastanesinin acil servisinde gerçekleştirildi. Ocak 2016 ile Temmuz 2016 tarihleri arasında nefes darlığı yakınması veya kalp yetmezliği tanısı olan 18 yaş üstü hastalar çalışmaya alındı. Hastaların BLUE protokolünde belirtilen bölgelere göre B çizgisi sayısı ölçüldü. Klinik kalp yetmezliği evresi, NT-proBNP düzeyi ve akciğer ultrasonografisindeki B-çizgisi sayısı arasındaki ilişkiler analiz edildi. Toplam 143 hastanın 92'si (% 64,3) erkek, 51'i (% 35,7) kadındı. Ortanca yaş 73,00 (66,00-79,00) idi. Her bölge için B çizgilerinin sayısı ve NYHA aşamaları arasında çok güçlü bir korelasyon vardı (tüm değişkenler için r >0.85; tümü için p <0.001). Ayrıca her bölge için B çizgilerinin sayısı ile NT-proBNP seviyeleri arasında güçlü ve doğrudan bir korelasyon vardı (r> 0.70; p <0.001). Nefes darlığı sayısal skoru (r> 0.45; p <0.001) ile ejeksiyon fraksiyonu (EF) arasında ters bir ilişki vardı. EF ve BLUE noktaları arasındaki ilişki orta düzeyde, ancak negatif ve anlamlıydı (p <0.001). NT-proBNP seviyeleri, NHYA sınıflandırması ve akciğer ultrasonu, acil serviste akciğer konjesyonunda daha hızlı tanı ve karar verme için bir araç olarak kullanılabilir.
References
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- 2. Lichtenstein DA, Meziere GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest 2008;134:117-25.
- 3. Jambrik Z, Monti S, Coppola V, Agricola E, Mottola G, Miniati M, et al. Usefulness of ultrasound lung comets as a nonradiologic sign of extravascular lung water. Am J Cardiol 2004;93:1265-70.
- 4. Agricola E, Bove T, Oppizzi M, Marino G, Zangrillo A, Margonato A, et al. “Ultrasound comet-tail images”: a marker of pulmonary edema: a comparative study with wedge pressure and extravascular lung water. Chest 2005;127:1690-5.
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- 9. Maisel AS, Krishnaswamy P, Nowak RM, McCord J, Hollander JE, Duc P, et al.; Breathing Not Properly Multinational Study Investigators. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 2002;347:161-7.
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- 12. Palmer SC, Yandle TG, Nicholls MG, Frampton CM, Richards AM. Regional clearance of amino‐terminal pro‐brain natriuretic peptide from human plasma. Eur J Heart Fail 2009;11:832-9.
- 13. van Kimmenade RR, Januzzi JL Jr, Bakker JA, Houben AJ, Rennenberg R, Kroon AA, et al. Renal clearance of B-type natriuretic peptide and amino terminal pro-B-type natriuretic peptide: a mechanistic study in hypertensive subjects. J Am Coll Cardiol 2009;53:884-90.
- 14. Januzzi JL, Chen-Tournoux AA, Moe G. Amino-terminal pro–B-type natriuretic peptide testing for the diagnosis or exclusion of heart failure in patients with acute symptoms. Am J Cardiol 2008;101:S29-38.
- 15. Cleland JG, McDonagh T, Rigby AS, Yassin A, Whittaker T, Dargie HJ; National Heart Failure Audit Team for England and Wales. The national heart failure audit for England and Wales 2008–2009. Heart 2011;97:876-86.
- 16. Zoghi M, Cavusoglu Y, Yilmaz MB, Nalbantgil S, Eren M, Mebazaa A. Practical approach to acute heart failure with algorithms [Article in Turkish]. Anadolu Kardiyol Derg 2009;9:436-46.
- 17. Lam CS, Burnett JC, Costello-Boerrigter L, Rodeheffer RJ, Redfield MM. Alternate circulating pro-B-type natriuretic peptide and B-type natriuretic peptide forms in the general population. J Am Coll Cardiol 2007;49:1193-202.
- 18. Glöckner E, Christ M, Geier F, Otte P, Thiem U, Neubauer S, et al. Accuracy of Point-of-Care B-Line Lung Ultrasound in Comparison to NT-ProBNP for Screening Acute Heart Failure. Ultrasound Int Open 2016;2:E90-2.
- 19. Peacock WF 4th. The B-type natriuretic peptide assay: a rapid test for heart failure. Cleve Clin J Med 2002;69:243-51.
- 20. Aggarwal M, Gupta M, Vijan V, Vupputuri A, Chintamani S, Rajendran B, et al. Use of Lung Ultrasound For Diagnosing Acute Heart Failure in Emergency Department of Southern India. J Clin Diagn Res 2016;10:TC05-8.
- 21. Coiro S, Porot G, Rossignol P, Ambrosio G, Carluccio E, Tritto I, et al. Prognostic value of pulmonary congestion assessed by lung ultrasound imaging during heart failure hospitalisation: A two-centre cohort study. Sci Rep 2017;7:43972.
- 22. Sudharshana Murthy KA, Ashoka HG, Aparna AN. Evaluation and comparison of biomarkers in heart failure. Indian Heart J 2016;68:S22-8.
- 23. Coiro S, Rossignol P, Ambrosio G, Carluccio E, Alunni G, Murrone A, et al. Prognostic value of residual pulmonary congestion at discharge assessed by lung ultrasound imaging in heart failure. Eur J Heart Fail 2015;17:1172-81.
- 24. Gargani L, Pang PS, Frassi F, Miglioranza MH, Dini FL, Landi P, et al. Persistent pulmonary congestion before discharge predicts rehospitalization in heart failure: a lung ultrasound study. Cardiovasc Ultrasound 2015;13:40.
- 25. Pivetta E, Goffi A, Lupia E, Tizzani M, Porrino G, Ferreri E, et al.; SIMEU Group for Lung Ultrasound in the Emergency Department in Piedmont. Lung ultrasound-implemented diagnosis of acute decompensated heart failure in the ED: A SIMEU Multicenter Study. Chest 2015;148:202-10.
- 26. Gallard E, Redonnet JP, Bourcier JE, Deshaies D, Largeteau N, Amalric JM, et al. Diagnostic performance of cardiopulmonary ultrasound performed by the emergency physician in the management of acute dyspnea. Am J Emerg Med 2015;33:352-8.
- 27. Liu ZP, Zhang Y, Bian H, He XR, Zhou YJ, Wang LJ, et al. Clinical application of rapid B-line score with lung ultrasonography in differentiating between pulmonary infection and pulmonary infection with acute left ventricular heart failure. Am J Emerg Med 2016;34:278-81.
- 28. Sartini S, Frizzi J, Borselli M, Sarcoli E, Granai C, Gialli V, et al. Which method is best for an early accurate diagnosis of acute heart failure? Comparison between lung ultrasound, chest X-ray and NT pro-BNP performance: a prospective study. Intern Emerg Med 2017;12:861-9.
- 29. Vodovar N, Séronde MF, Laribi S, Gayat E, Lassus J, Boukef R, et al.; GREAT Network. Post-translational modifications enhance NT-proBNP and BNP production in acute decompensated heart failure. Eur Heart J 2014;35:3434-41.
- 30. Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 2009;22:107-33.
- 31. Giannese D, Puntoni A, Cupisti A, Morganti R, Varrichio E, D’Alessandro C, et al. Lung ultrasound and BNP to detect hidden pulmonary congestion in euvolemic hemodialysis patients: a single centre experience. BMC Nephrol 22, 36 (2021). https://doi.org/10.1186/s12882-020-02210-z
- 32. Ngoh CLY, Teng HL, Chua YT, Leo CCH, Wong WK. Comparison between lung ultrasonography and current methods for volume assessment in Asian chronic hemodialysis patients. Hemodial Int. 2020 Oct;24(4):516-527. doi: 10.1111/hdi.12871. Epub 2020 Aug 18. PMID: 32809269.
Strong and Direct Correlation in Heart Failure Between B-Lines and NT-ProBNP Levels
Year 2021,
Volume: 43 Issue: 6, 640 - 647, 24.09.2021
Hakan Dolgun
,
Nurdan Acar
,
Engin Özakın
,
Filiz Kaya
,
Mustafa Emin Çanakçı
,
Ebubekir Arslan
,
Turgay Çağlayan
Abstract
The aim of the study was to evaluate the compliance of the number of B-lines on focused lung ultrasound with the clinical heart failure classification of the New York Heart Association (NYHA) and NT-proBNP levels in the emergency department. This prospective study was conducted in a tertiary university hospital emergency department. Patients over 18 years of age complaining of shortness of breath or heart failure diagnosis between January 2016 and July 2016. The number of B-lines according to the BLUE point regions was measured. Correlations between the clinical heart failure stage, NT-proBNP level and number of B-lines on ultrasonography were analyzed. Of the 143 patients, 92 (64.3%) were male and 51 (35.7%) were female. The median age was 73.00 (66.00-79.00). There was a very strong correlation between the number of B-lines and NYHA stages for each region (r > 0.85 for all variables; p <0.001 for all). There was also a strong and direct correlation between the number of B-lines and the NT-proBNP levels for each region (r > 0.70; p <0.001). Regarding the shortness of breath numerical score (r > 0.45; p <0.001), there was an inverse relationship with ejection fraction (EF). The relationship between the EF and BLUE points was moderate, but negative and significant (p <0.001). NT-proBNP levels, the NHYA classification, and lung ultrasound can be used as a tool in the emergency department for a faster diagnosis and decision-making in lung congestion.
References
- 1. Gheorghiade M, Filippatos G, De Luca L, Burnett J. Congestion in acute heart failure syndromes: an essential target of evaluation and treatment. Am J Med 2006;119:S3-10.
- 2. Lichtenstein DA, Meziere GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest 2008;134:117-25.
- 3. Jambrik Z, Monti S, Coppola V, Agricola E, Mottola G, Miniati M, et al. Usefulness of ultrasound lung comets as a nonradiologic sign of extravascular lung water. Am J Cardiol 2004;93:1265-70.
- 4. Agricola E, Bove T, Oppizzi M, Marino G, Zangrillo A, Margonato A, et al. “Ultrasound comet-tail images”: a marker of pulmonary edema: a comparative study with wedge pressure and extravascular lung water. Chest 2005;127:1690-5.
- 5. Agricola E, Picano E, Oppizzi M, Pisani M, Meris A, Fragasso G, et al. Assessment of stress-induced pulmonary interstitial edema by chest ultrasound during exercise echocardiography and its correlation with left ventricular function. J Am Soc Echocardiogr 2006;19:457-63.
- 6. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al.; ESC Scientific Document Group. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016;18:891-975.
- 7. Felker GM, Hasselblad V, Hernandez AF, O'Connor CM. Biomarker-guided therapy in chronic heart failure: a meta-analysis of randomized controlled trials. Am Heart J 2009;158:422-30.
- 8. Januzzi JL Jr, Peacock WF, Maisel AS, Chae CU, Jesse RL, Baggish AL, et al. Measurement of the interleukin family member ST2 in patients with acute dyspnea: results from the PRIDE (Pro-Brain Natriuretic Peptide Investigation of Dyspnea in the Emergency Department) study. J Am Coll Cardiol 2007;50:607-13.
- 9. Maisel AS, Krishnaswamy P, Nowak RM, McCord J, Hollander JE, Duc P, et al.; Breathing Not Properly Multinational Study Investigators. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 2002;347:161-7.
- 10. Sachdeva A, Horwich TB, Fonarow GC. Comparison of usefulness of each of five predictors of mortality and urgent transplantation in patients with advanced heart failure. Am J Cardiol 2010;106:830-5.
- 11. Januzzi JL Jr, Camargo CA, Anwaruddin S, Baggish AL, Chen AA, Krauser DG, et al. The N-terminal Pro-BNP investigation of dyspnea in the emergency department (PRIDE) study. Am J Cardiol 2005;95:948-54.
- 12. Palmer SC, Yandle TG, Nicholls MG, Frampton CM, Richards AM. Regional clearance of amino‐terminal pro‐brain natriuretic peptide from human plasma. Eur J Heart Fail 2009;11:832-9.
- 13. van Kimmenade RR, Januzzi JL Jr, Bakker JA, Houben AJ, Rennenberg R, Kroon AA, et al. Renal clearance of B-type natriuretic peptide and amino terminal pro-B-type natriuretic peptide: a mechanistic study in hypertensive subjects. J Am Coll Cardiol 2009;53:884-90.
- 14. Januzzi JL, Chen-Tournoux AA, Moe G. Amino-terminal pro–B-type natriuretic peptide testing for the diagnosis or exclusion of heart failure in patients with acute symptoms. Am J Cardiol 2008;101:S29-38.
- 15. Cleland JG, McDonagh T, Rigby AS, Yassin A, Whittaker T, Dargie HJ; National Heart Failure Audit Team for England and Wales. The national heart failure audit for England and Wales 2008–2009. Heart 2011;97:876-86.
- 16. Zoghi M, Cavusoglu Y, Yilmaz MB, Nalbantgil S, Eren M, Mebazaa A. Practical approach to acute heart failure with algorithms [Article in Turkish]. Anadolu Kardiyol Derg 2009;9:436-46.
- 17. Lam CS, Burnett JC, Costello-Boerrigter L, Rodeheffer RJ, Redfield MM. Alternate circulating pro-B-type natriuretic peptide and B-type natriuretic peptide forms in the general population. J Am Coll Cardiol 2007;49:1193-202.
- 18. Glöckner E, Christ M, Geier F, Otte P, Thiem U, Neubauer S, et al. Accuracy of Point-of-Care B-Line Lung Ultrasound in Comparison to NT-ProBNP for Screening Acute Heart Failure. Ultrasound Int Open 2016;2:E90-2.
- 19. Peacock WF 4th. The B-type natriuretic peptide assay: a rapid test for heart failure. Cleve Clin J Med 2002;69:243-51.
- 20. Aggarwal M, Gupta M, Vijan V, Vupputuri A, Chintamani S, Rajendran B, et al. Use of Lung Ultrasound For Diagnosing Acute Heart Failure in Emergency Department of Southern India. J Clin Diagn Res 2016;10:TC05-8.
- 21. Coiro S, Porot G, Rossignol P, Ambrosio G, Carluccio E, Tritto I, et al. Prognostic value of pulmonary congestion assessed by lung ultrasound imaging during heart failure hospitalisation: A two-centre cohort study. Sci Rep 2017;7:43972.
- 22. Sudharshana Murthy KA, Ashoka HG, Aparna AN. Evaluation and comparison of biomarkers in heart failure. Indian Heart J 2016;68:S22-8.
- 23. Coiro S, Rossignol P, Ambrosio G, Carluccio E, Alunni G, Murrone A, et al. Prognostic value of residual pulmonary congestion at discharge assessed by lung ultrasound imaging in heart failure. Eur J Heart Fail 2015;17:1172-81.
- 24. Gargani L, Pang PS, Frassi F, Miglioranza MH, Dini FL, Landi P, et al. Persistent pulmonary congestion before discharge predicts rehospitalization in heart failure: a lung ultrasound study. Cardiovasc Ultrasound 2015;13:40.
- 25. Pivetta E, Goffi A, Lupia E, Tizzani M, Porrino G, Ferreri E, et al.; SIMEU Group for Lung Ultrasound in the Emergency Department in Piedmont. Lung ultrasound-implemented diagnosis of acute decompensated heart failure in the ED: A SIMEU Multicenter Study. Chest 2015;148:202-10.
- 26. Gallard E, Redonnet JP, Bourcier JE, Deshaies D, Largeteau N, Amalric JM, et al. Diagnostic performance of cardiopulmonary ultrasound performed by the emergency physician in the management of acute dyspnea. Am J Emerg Med 2015;33:352-8.
- 27. Liu ZP, Zhang Y, Bian H, He XR, Zhou YJ, Wang LJ, et al. Clinical application of rapid B-line score with lung ultrasonography in differentiating between pulmonary infection and pulmonary infection with acute left ventricular heart failure. Am J Emerg Med 2016;34:278-81.
- 28. Sartini S, Frizzi J, Borselli M, Sarcoli E, Granai C, Gialli V, et al. Which method is best for an early accurate diagnosis of acute heart failure? Comparison between lung ultrasound, chest X-ray and NT pro-BNP performance: a prospective study. Intern Emerg Med 2017;12:861-9.
- 29. Vodovar N, Séronde MF, Laribi S, Gayat E, Lassus J, Boukef R, et al.; GREAT Network. Post-translational modifications enhance NT-proBNP and BNP production in acute decompensated heart failure. Eur Heart J 2014;35:3434-41.
- 30. Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 2009;22:107-33.
- 31. Giannese D, Puntoni A, Cupisti A, Morganti R, Varrichio E, D’Alessandro C, et al. Lung ultrasound and BNP to detect hidden pulmonary congestion in euvolemic hemodialysis patients: a single centre experience. BMC Nephrol 22, 36 (2021). https://doi.org/10.1186/s12882-020-02210-z
- 32. Ngoh CLY, Teng HL, Chua YT, Leo CCH, Wong WK. Comparison between lung ultrasonography and current methods for volume assessment in Asian chronic hemodialysis patients. Hemodial Int. 2020 Oct;24(4):516-527. doi: 10.1111/hdi.12871. Epub 2020 Aug 18. PMID: 32809269.