Guided therapy in patients with acute heart failure: left ventricular diastolic filling pattern and NT-proBNP

Abstract

Aim: N-terminal pro B-type natriuretic peptide has been commonly used in acute heart failure. We investigated whether the Doppler transmitral flow parameters on admission and discharge offer a useful guide like N-terminal pro B-type natriuretic peptide levels in acute heart failure.
Material and Method: This study with a prospective randomized design included 57 patients admitted to the emergency department between October 2019 and March 2020. All patients had New York Heart Association class IV, had sinus rhythm, and were diagnosed previously with dilate cardiomyopathy. The left ventricular diastolic filling pattern during admission and discharge was evaluated in all patients using transthoracic echocardiography. N-terminal pro B-type natriuretic peptide levels were analyzed on admission and discharge to compare the left ventricular filling pattern.
Results: The average age of the patients was 64.94±5.56 years. During admission, the left ventricular filling pattern of all patients was of restrictive type (type III), whereas during discharge, 46 patients had abnormal relaxation (type I) and 11 patients had pseudonormal (type II) filling pattern. N-terminal pro B-type natriuretic peptide levels were 8004.75±743 pg/mL and 1645.17±104.58 pg/mL during admission and discharge, respectively. The mean e/e’ ratio of the patients was 14.83±0.25 and 7.70±0.14 and E/A ratio was 2.51±0.35 and 1.42±0.33 during admission and discharge, respectively. N-terminal pro B-type natriuretic peptide levels with regard to the mitral filling pattern were different during discharge. The N-terminal pro B-type natriuretic peptide level with an abnormal relaxation pattern was 1440.43±144.75 pg/mL and that with a pseudonormal pattern was 1957.60±64.00 pg/mL (p=0.003).
Conclusion: Our study demonstrated that the left ventricular filling pattern successfully guided in acute heart failure therapy, similar to N-terminal pro B-type natriuretic peptide -guided therapy.

Keywords

• acute heart failure,left ventricular filling pattern,guided therapy

Akut kalp yetmezlikli hastalarda kılavuz tedavi: sol ventrikül doluş bulguları ve NT-proBNP

Abstract

Amaç: N-terminal pro B tip natriüretik peptid akut kalp yetmezliğinde sıklıkla kullanılır. Bu çalışmada, akut kalp yetmezlikli hastaların Doppler transmitral akım parametrelerinin hastaneye kabul ve taburculukta N-terminal pro B tip natriüretik peptid gibi faydalı bir yaklaşım olup olamayacağını araştırdık.
Gereç ve Yöntem: Prospective randomize tasarlanan bu çalışma Ekim 2019-Mart 2020 arası acil bölümüne kabul edilen 57 hastaya kapsamaktadır. Tüm hastalar New York Heart Association sınıf IV olup sinüs ritminde ve önceden dilate kardiyomiyopati tanısı almışlardı. Hastalara giriş ve taburculukta transtorasik ekokardiyografi ile sol ventrikül diyastolik doluş paternleri değerlendirildi. Giriş ve çıkış N-terminal pro B tip natriüretik peptid seviyeleri sol venrtrikül doluş bulguları ile karşılaştırıldı.
Bulgular: Ortalama yaş 64,94±5,56 idi. Girişte tüm hastaların sol ventrikül doluş paternleri restriktif tip doluş bozukluğu idi. Taburculukta 46 hasta anormal relaksasyon bozukluğu (Tip I), 11 hasta pseudonormal doluş bozukluğu (Tip II) vardı. N-terminal pro B tip natriüretik peptid seviyeleri girişte 8004,75±743 pg/mL, taburculukta 1645,17±104,58 pg/mL idi. Ortalama e/e’ oranı girişte 14,83±0,25 taburculukta 7,70±0,14 idi. Ortalama E/A oranı girişte 2,51±0,35 taburculukta 1,42±0,33 idi. Anormal relaksasyon tipte N-terminal pro B tip natriüretikpeptidseviyeleri 1440,43±144,75 pg/mL, oysa pseudonormal pattern de N-terminal pro B tip natriüretik peptid seviyeleri 1957,60±64,00 pg/mL (p=0,003).
Sonuç: Akut kalp yetmezlikli hastalarda sol ventrikül doluş paternleri N-terminal pro B tip natriüretik peptid rehberliği gibi başarılı bir şekilde kullanılabileceğini göstermiştir.

Keywords

• Akut kalp yetmezliği,sol ventrikül doluş bulguları,kılavuz tedavi

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