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Prognostic significance of B-type natriuretic peptide and pulmonary arterial pressure in patients with acute heart failure
M Deljanin Ilic1
1Institute for treatment and rehabilitation Niska Banja, Clinic for cardiology - Nis - Serbia
European Journal of Heart Failure
Background: Natriuretic peptide has become the gold standard for diagnosis in patients with acute heart failure due to antifibrotic and antiproliferative actions. There are few studies that have investigated the significance of the parameters of the right ventricle in predicting the mortality of patients with ahf.
Purpose: To investigate association B-type natriuretic peptide (BNP) level with pulmonary arterial pressure (PAP) and to estimate their prognostic significance on one-year mortality in patients with acute heart failure (AHF).
Methods: The prospective study evaluated 225 patients (pts) (70.29±9.74 years) who were admitted to Intensive care unit due to signs and symptoms of AHF during three years. The values of BNP were determined during the first 24 hours after admission in all subjects. Two-dimensional and doppler echocardiography was performed in all patients. Post-discharge mortality was observed one year. All medical therapy was documented, and for this analysis, we focused on the impact BNP, the right ventricular diameter, PAP on one-year mortality.
Results: Out of 225 pts, those with PAP<40 mmHg (n=104) had lower value of BNP, than pts (n=121) with PAP=40 mmHg (P<0.001). Pts with right ventricular diameter =30 mm (n=158) had lower value of BNP than pts (n=67) with right ventricular diameter >30 mmHg (P<0.001). Total one-year mortality was 34.7% (78 pts). As compared with the group of survivors (n=147) the group of non-survivors had higher values of BNP (853.10±384.92 vs 1399.68±464.44 pg/mL, P<0.001), right ventricular diameter (27.02±3.93 vs 31.09±5.60 mm, P<0.001) and PAP (40.09±8.24 vs 49.67±10.65 mmHg, P<0.001). There was a significant positive correlation BNP and PAP (?=0.255, P<0.001) and BNP and right ventricular diameter (?=0.304, P<0.001). After multivariate adjustment, using age, sex, body mass index, blood pressure, right ventricular diameter as covariates, logistic regression analysis independent predictors for one-year mortality were: BNP (OR 1.003, CI 1.002-1.004, P<0.001), and PAP (OR 1.099, CI 1.038-1.164, p<0.001). The cut-off value of BNP= 1062.04 pg/ml was associated with a higher risk of one-years mortality (AUC=0.820, P<0.001; sensitivity 74.4%, specificity 72.8%). The cut-off value of PAP=44.5 mmHg was also associated with a higher risk of mortality (AUC=0.776, P<0.001).
Conclusion: Our results show that BNP levels are strongly associated with pulmonary arterial pressure in hospitalized patients with acute heart failure. The most significant and independent predictors of one-year mortality are BNP and the PAP in patients with AHF.
The simultaneous application of echocardiography (parameters of right ventricular function) and laboratory biomarkers (BNP) in the early phase of hospitalization, can help fast and accurate diagnosis od AHF.
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