Echo- and B-Type Natriuretic Peptide-Guided Follow-Up versus Symptom-Guided Follow-Up: Comparison of the Outcome in Ambulatory Heart Failure Patients
Recent European Society of Cardiology and American Heart Association/American College of Cardiology Guidelines did not recommend biomarker-guided therapy in the management of heart failure (HF) patients. Combination of echo- and B-type natriuretic peptide (BNP) may be an alternative approach in guid...
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| Format: | Article |
| Language: | English |
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Wiley
2018-01-01
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| Series: | Cardiology Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2018/3139861 |
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| author | Gani Bajraktari Nicola Riccardo Pugliese Andreina D’Agostino Gian Marco Rosa Pranvera Ibrahimi Luan Perçuku Mario Miccoli Gian Giacomo Galeotti Iacopo Fabiani Roberto Pedrinelli Michael Henein Frank L. Dini |
| author_facet | Gani Bajraktari Nicola Riccardo Pugliese Andreina D’Agostino Gian Marco Rosa Pranvera Ibrahimi Luan Perçuku Mario Miccoli Gian Giacomo Galeotti Iacopo Fabiani Roberto Pedrinelli Michael Henein Frank L. Dini |
| author_sort | Gani Bajraktari |
| collection | DOAJ |
| description | Recent European Society of Cardiology and American Heart Association/American College of Cardiology Guidelines did not recommend biomarker-guided therapy in the management of heart failure (HF) patients. Combination of echo- and B-type natriuretic peptide (BNP) may be an alternative approach in guiding ambulatory HF management. Our aim was to determine whether a therapy guided by echo markers of left ventricular filling pressure (LVFP), lung ultrasound (LUS) assessment of B-lines, and BNP improves outcomes of HF patients. Consecutive outpatients with LV ejection fraction (EF) ≤ 50% have been prospectively enrolled. In Group I (n=224), follow-up was guided by echo and BNP with the goal of achieving E-wave deceleration time (EDT) ≥ 150 ms, tissue Doppler index E/e′ < 13, B-line numbers < 15, and BNP ≤ 125 pg/ml or decrease >30%; in Group II (n=293), follow-up was clinically guided, while the remaining 277 patients (Group III) did not receive any dedicated follow-up. At 60 months, survival was 88% in Group I compared to 75% in Group II and 54% in Group III (χ2 53.5; p<0.0001). Survival curves exhibited statistically significant differences using Mantel–Cox analysis. The number needed to treat to spare one death was 7.9 (Group I versus Group II) and 3.8 (Group I versus Group III). At multivariate Cox regression analyses, major predictors of all-cause mortality were follow-up E/e′ (HR: 1.05; p=0.0038) and BNP >125 pg/ml or decrease ≤30% (HR: 4.90; p=0.0054), while BNP > 125 pg/ml or decrease ≤30% and B-line numbers ≥15 were associated with the combined end point of death and HF hospitalization. Evidence-based HF treatment guided by serum biomarkers and ultrasound with the goal of reducing elevated BNP and LVFP, and resolving pulmonary congestion was associated with better clinical outcomes and can be valuable in guiding ambulatory HF management. |
| format | Article |
| id | doaj-art-83d990c1c9984703a738d77540a91568 |
| institution | Kabale University |
| issn | 2090-8016 2090-0597 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
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| series | Cardiology Research and Practice |
| spelling | doaj-art-83d990c1c9984703a738d77540a915682025-02-03T01:24:24ZengWileyCardiology Research and Practice2090-80162090-05972018-01-01201810.1155/2018/31398613139861Echo- and B-Type Natriuretic Peptide-Guided Follow-Up versus Symptom-Guided Follow-Up: Comparison of the Outcome in Ambulatory Heart Failure PatientsGani Bajraktari0Nicola Riccardo Pugliese1Andreina D’Agostino2Gian Marco Rosa3Pranvera Ibrahimi4Luan Perçuku5Mario Miccoli6Gian Giacomo Galeotti7Iacopo Fabiani8Roberto Pedrinelli9Michael Henein10Frank L. Dini11Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, SwedenCardiac, Thoracic and Vascular Department, University of Pisa, Pisa, ItalyCardiac, Thoracic and Vascular Department, University of Pisa, Pisa, ItalyDepartment of Internal Medicine, University of Genoa, Genoa, ItalyDepartment of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, SwedenClinic of Cardiology, University Clinical Centre of Kosova, Prishtina, KosovoDepartment of Clinical and Experimental Medicine, University of Pisa, Pisa, ItalyCardiac, Thoracic and Vascular Department, University of Pisa, Pisa, ItalyCardiac, Thoracic and Vascular Department, University of Pisa, Pisa, ItalyCardiac, Thoracic and Vascular Department, University of Pisa, Pisa, ItalyDepartment of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, SwedenCardiac, Thoracic and Vascular Department, University of Pisa, Pisa, ItalyRecent European Society of Cardiology and American Heart Association/American College of Cardiology Guidelines did not recommend biomarker-guided therapy in the management of heart failure (HF) patients. Combination of echo- and B-type natriuretic peptide (BNP) may be an alternative approach in guiding ambulatory HF management. Our aim was to determine whether a therapy guided by echo markers of left ventricular filling pressure (LVFP), lung ultrasound (LUS) assessment of B-lines, and BNP improves outcomes of HF patients. Consecutive outpatients with LV ejection fraction (EF) ≤ 50% have been prospectively enrolled. In Group I (n=224), follow-up was guided by echo and BNP with the goal of achieving E-wave deceleration time (EDT) ≥ 150 ms, tissue Doppler index E/e′ < 13, B-line numbers < 15, and BNP ≤ 125 pg/ml or decrease >30%; in Group II (n=293), follow-up was clinically guided, while the remaining 277 patients (Group III) did not receive any dedicated follow-up. At 60 months, survival was 88% in Group I compared to 75% in Group II and 54% in Group III (χ2 53.5; p<0.0001). Survival curves exhibited statistically significant differences using Mantel–Cox analysis. The number needed to treat to spare one death was 7.9 (Group I versus Group II) and 3.8 (Group I versus Group III). At multivariate Cox regression analyses, major predictors of all-cause mortality were follow-up E/e′ (HR: 1.05; p=0.0038) and BNP >125 pg/ml or decrease ≤30% (HR: 4.90; p=0.0054), while BNP > 125 pg/ml or decrease ≤30% and B-line numbers ≥15 were associated with the combined end point of death and HF hospitalization. Evidence-based HF treatment guided by serum biomarkers and ultrasound with the goal of reducing elevated BNP and LVFP, and resolving pulmonary congestion was associated with better clinical outcomes and can be valuable in guiding ambulatory HF management.http://dx.doi.org/10.1155/2018/3139861 |
| spellingShingle | Gani Bajraktari Nicola Riccardo Pugliese Andreina D’Agostino Gian Marco Rosa Pranvera Ibrahimi Luan Perçuku Mario Miccoli Gian Giacomo Galeotti Iacopo Fabiani Roberto Pedrinelli Michael Henein Frank L. Dini Echo- and B-Type Natriuretic Peptide-Guided Follow-Up versus Symptom-Guided Follow-Up: Comparison of the Outcome in Ambulatory Heart Failure Patients Cardiology Research and Practice |
| title | Echo- and B-Type Natriuretic Peptide-Guided Follow-Up versus Symptom-Guided Follow-Up: Comparison of the Outcome in Ambulatory Heart Failure Patients |
| title_full | Echo- and B-Type Natriuretic Peptide-Guided Follow-Up versus Symptom-Guided Follow-Up: Comparison of the Outcome in Ambulatory Heart Failure Patients |
| title_fullStr | Echo- and B-Type Natriuretic Peptide-Guided Follow-Up versus Symptom-Guided Follow-Up: Comparison of the Outcome in Ambulatory Heart Failure Patients |
| title_full_unstemmed | Echo- and B-Type Natriuretic Peptide-Guided Follow-Up versus Symptom-Guided Follow-Up: Comparison of the Outcome in Ambulatory Heart Failure Patients |
| title_short | Echo- and B-Type Natriuretic Peptide-Guided Follow-Up versus Symptom-Guided Follow-Up: Comparison of the Outcome in Ambulatory Heart Failure Patients |
| title_sort | echo and b type natriuretic peptide guided follow up versus symptom guided follow up comparison of the outcome in ambulatory heart failure patients |
| url | http://dx.doi.org/10.1155/2018/3139861 |
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