Early identification of acute heart failure at the time of presentation: do natriuretic peptides make the difference?

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiorenal syndrome (CRS) is common in patients with acute heart failure (AHF) and is associated with poor prognosis. Levosimendan (LVS) is an inodilator used in AHF and has beneficial effects on renal function (RF). However, its effects on RF in CRS patients are not established. Purpose To evaluate whether LVS could improve RF in AHF patients with or without CRS. Methods Retrospective study that included patients with AHF treated with LVS in a cardiac intensive care unit of a tertiary center, between January 2015 and June 2018. Baseline serum creatinine (SCr) was recorded and SCr and glomerular filtration rate (GFR) were accessed before and within 5 days after LSV use. CRS was defined as an increase in SCr > 0,3 mg/dL over baseline (before LVS use). RF improvement was defined as a decrease in SCr after LVS use. We evaluate outcomes at 1-year. Results 61 patients were included, 84% males, mean age 65 years, ejection fraction ≤40% in 87%. INTERMACS 4 and hemodynamic profile C were the most frequent presentation. LSV was administered in 24h, without bolus, in most patients. CRS was present in 44,3% of patients. Basal characteristics were similar between CRS and no-CRS patients, including prevalence of chronic kidney disease, baseline SCr or natriuretic peptides (p> 0,05 for all). CRS patients had a significant improvement in RF after LVS use (SCr 2,08 to 1,65 mg/dL, p< 0,001 and GFR 40,4 to 54,6 mL/min/m2, p< 0,001), while no-CRS patients had no significant improvement in RF (SCr 1,33 to 1,32 mg/dL and GFR 64,1 to 64,5 mL/min/m2, p> 0,05 for all). Also, there was a significant decrease in natriuretic peptides after LVS in CRS patients (NT-proBNP 13527,5 to 10708,8 pg/mL, p= 0,006), without significant differences in no-CRS patients. It is noteworthy that at discharge, CRS patients were more likely to titrate HF optimal medical therapy (OMT) compared with no-CRS patients (p= 0,039). There was a lower tendency to suspend angiotensin-converting enzyme (ACE-I) and angiotensin receptor blockers (ARB) in CRS patients (p= 0,05). At discharge CRS patients received more furosemide than at admission (77,2 mg/day to 97,1 mg/day, p= 0,019) compared with no-CRS patients (89,6 mg/day to 97,0 mg/day, p= 0,469), receiving similar doses at discharge. In CRS patients, RF improvement was associated with a decrease in intra-hospital mortality (p= 0,043) and a tendency to decrease 30-day mortality (p= 0,060), but without differences in one-year mortality. Conclusion In CRS patients, LVS improved RF and NT-proBNP, allowed to titrate OMT and decreased the need to suspend ACE-I or ARB and was associated to a decrease in short-term mortality.

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Extrém magas B típusú natriureticus prohormon prognosztikai szerepe a szívelégtelenség miatt kezelt betegek kórházi halálozására

Orvosi Hetilap ◽

10.1556/650.2017.30761 ◽

2017 ◽

Vol 158 (20) ◽

pp. 779-782

Author(s):

Béla Bózsik ◽

Erzsébet Nagy ◽

Miklós Somlói ◽

János Tomcsányi

Keyword(s):

Heart Failure ◽

Hospital Mortality ◽

Hospital Stay ◽

Natriuretic Peptide ◽

Natriuretic Peptides ◽

Prognostic Value ◽

Response To Therapy ◽

Cardiology Department ◽

The Difference ◽

One Year

Abstract: Introduction: Patients hospitalized for heart failure have a very high in-hospital as well as one-year mortality. Natriuretic peptides play both a diagnostic and a prognostic role in this disease. Changes of natriuretic peptide levels in response to therapy are a well-known prognostic marker. Regarding in-hospital mortality, however, little is known about the prognostic value of extremely high levels of natriuretic peptides measured on admission. Aim: To decide whether extremely high levels of B-type natriuretic peptide have a prognostic value with regard to in-hospital mortality. Method: NT-proBNP levels on admission and in-hospital mortality were extracted retrospectively from the data of patients treated with heart failure in the cardiology department of the Hospital of St. John of God in Budapest. We separately analyzed the data of patients hospitalized for heart failure in 2015 with extremely high initial NT-proBNP levels. The cut-off value in this regard was 10 000 ng/l. We also analyzed the comorbidities of these patients. Results: The median NT-proBNP level of those patients who survived beyond the index hospital stay in the last 10 years was 4842 ng/l, whereas the median NT-proBNP level of those 182 patients who died during their hospital stay was 10 688 ng/l (p<0.001). In the year 2015, we treated 118 patients with an NT-proBNP level above 10 000 ng/l. Thirteen of these patients died, which means that their in-hospital mortality exceeded 10%. In comparison, the in-hospital mortality of all heart failure patients was 5.8%. The difference of median NT-proBNP levels of surviving versus deceased patients in this group with extremely high NT-proBNP levels was no longer significant (17 080 ng/l vs. 19 152 ng/l). Conclusions: Patients with an NT-proBNP level of >10 000 ng/l on admission have a significantly higher in-hospital mortality. The difference of NT-proBNP levels of surviving versus deceased patients in the group with admission NT-proBNP levels >10 000 ng/l is no longer significant. We could not identify any etiological factors that would explain these extremely high NT-proBNP levels or the excess in-hospital mortality. Orv Hetil. 2017; 158(20): 779–782.

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Biomarkers in acute heart failure

10.1093/med/9780199687039.003.0037 ◽

2015 ◽

Author(s):

Rajiv Choudhary ◽

Kevin Shah ◽

Alan Maisel

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Natriuretic Peptides ◽

Health Care Systems ◽

Medical Problem ◽

National Health Care ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Acute Dyspnoea ◽

Care Systems ◽

Neutrophil Gelatinase

Acute heart failure continues to be a worldwide medical problem, associated with frequent readmissions, high mortality, and a profound economic impact on national health care systems. In the past decade, biomarkers have shifted the way in which acute heart failure is managed by the cardiologist. The search for the ideal biomarker to aid in the diagnosis, prognosis, and treatment of acute heart failure is ongoing. The natriuretic peptides have proved extremely useful in determining whether acute dyspnoea has a cardiac aetiology. In addition, recent trials have demonstrated the use of natriuretic peptides in inpatient and outpatient prognosis, as well as in titrating medications in outpatients with chronic heart failure to prevent acute heart failure hospitalizations. Other emerging acute heart failure biomarkers include mid-regional pro-adrenomedullin, mid-regional proatrial natriuretic peptide, troponin, ST2, and neutrophil gelatinase-associated lipocalin.

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B-type Natriuretic Peptides in the Management of Acute Heart Failure and Acute Coronary Syndromes

Asia Pacific Cardiology ◽

10.15420/apc.2007:1:1:22 ◽

2007 ◽

Vol 1 (1) ◽

pp. 22

Author(s):

Torbjørn Omland ◽

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Natriuretic Peptides ◽

Acute Coronary Syndromes ◽

Coronary Syndromes

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Natriuretic peptides for the treatment of acute heart failure: a focus on nesiritide in recent clinical trials

Expert Review of Cardiovascular Therapy ◽

10.1586/14779072.2015.1051034 ◽

2015 ◽

Vol 13 (7) ◽

pp. 743-751 ◽

Cited By ~ 5

Author(s):

Jeff Fajardo ◽

J Thomas Heywood ◽

J Herbert Patterson ◽

Kirkwood Adams ◽

Sheryl L Chow

Keyword(s):

Heart Failure ◽

Clinical Trials ◽

Acute Heart Failure ◽

Natriuretic Peptides

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The “Peptide for Life” Initiative: A Call for Action to Provide Equal Access for the Use of Natriuretic Peptides in the Diagnosis of Acute Heart Failure across Europe

European Journal of Heart Failure ◽

10.1002/ejhf.2293 ◽

2021 ◽

Author(s):

Antoni Bayes‐Genis ◽

James L Januzzi ◽

A Mark Richards ◽

Henrike Arfsten ◽

Rudolf A de Boer ◽

...

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Natriuretic Peptides ◽

Equal Access

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Diagnostic and Prognostic Value of Lung Ultrasound B-Lines in Acute Heart Failure With Concomitant Pneumonia

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.693912 ◽

2021 ◽

Vol 8 ◽

Author(s):

Matteo Mazzola ◽

Nicola Riccardo Pugliese ◽

Martina Zavagli ◽

Nicolò De Biase ◽

Giulia Bandini ◽

...

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Hospital Readmission ◽

Lung Ultrasound ◽

Adverse Outcome ◽

Prognostic Stratification ◽

The Difference ◽

B Lines ◽

Diagnostic And Prognostic Value

Purpose: To evaluate the potential confounding effect of concomitant pneumonia (PNM) on lung ultrasound (LUS) B-lines in acute heart failure (AHF).Methods: We enrolled 86 AHF patients with (31 pts, AHF/PNM) and without (55 pts, AHF) concomitant PNM. LUS B-lines were evaluated using a combined antero-lateral (AL) and posterior (POST) approach at admission (T0), after 24 h from T0 (T1), after 48 h from T0 (T2) and before discharge (T3). B-lines score was calculated at each time point on AL and POST chest, dividing the number of B-lines by the number of explorable scanning sites. The decongestion rate (DR) was calculated as the difference between the absolute B-lines number at discharge and admission, divided by the number of days of hospitalization. Patients were followed-up and hospital readmission for AHF was considered as adverse outcome.Results: At admission, AHF/PNM patients showed no difference in AL B-lines score compared with AHF patients [AHF/PNM: 2.00 (IQR: 1.44–2.94) vs. AHF: 1.65 (IQR: 0.50–2.66), p = 0.072], whereas POST B-lines score was higher [AHF/PNM: 3.76 (IQR: 2.70–4.77) vs. AHF = 2.44 (IQR: 1.20–3.60), p < 0.0001]. At discharge, AL B-lines score [HR: 1.907 (1.097–3.313), p = 0.022] and not POST B-lines score was found to predict adverse events (AHF rehospitalization) after a median follow-up of 96 days (IQR: 30–265) in the overall population.Conclusions: Assessing AL B-lines alone is adequate for diagnosis, pulmonary congestion (PC) monitoring and prognostic stratification in AHF patients, despite concomitant PNM.

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