Prognostic value of Doppler transmitral flow patterns and cardiac natriuretic peptides in patients with chronic congestive heart failure admitted for episodes of acute decompensation |
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Authors: | K Akioka Kazuhide Takeuchi Shiro Yanagi Kazuyoshi Hirota Kazuo Sakamoto Takayoshi Yoshimura I Toda Junichi Yoshikawa |
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Institution: | (1) First Department of Internal Medicine, Osaka City University, Medical School, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan Tel. +81-6-6645-3801; Fax +81-6-6645-3802 e-mail: akioka@med.osaka-cu.ac.jp, JP |
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Abstract: | This study was designed to determine whether the restrictive filling transmitral flow velocity pattern is associated with
increased plasma levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP). It was also designed to evaluate
the prognostic value of these parameters from patients with chronic congestive heart failure (CHF) admitted for episodes of
acute decompensation. We performed Doppler echocardiography, measured plasma levels of ANP and BNP in 33 patients at the time
of admission, and assessed the subsequent cardiac mortality for 3 months. Eleven patients (33%) had a restrictive filling
pattern of deceleration time (DcT) <120 ms. Plasma ANP and BNP levels were markedly increased in all patients to 189 ± 145
pg/ml and 865 ± 559 pg/ml, respectively. Seventeen patients (52%) showed more than 700 pg/ml of plasma levels of BNP. There
was a significant correlation of DcT with the plasma ANP level (r = −0.41, P = 0.017), and a better correlation of DcT with the plasma BNP level (r = −0.50, P = 0.003). The combined index of both shorter DcT (<120 ms) and higher plasma BNP levels (>700 pg/ml) was the best predictor
of cardiac mortality by Cox univariate analysis (χ2 = 5.87, P = 0.015). Furthermore, the sensitivity and specificity of this index for the detection of cardiac mortality were 80% and
86%, respectively. In conclusion, the combined analysis of the Doppler transmitral flow velocity pattern and measurement of
the plasma BNP level is noteworthy since it is noninvasive and convenient. Moreover, it is extremely useful in predicting
the prognosis for patients with chronic CHF admitted for episodes of acute decompensation.
Received: December 28, 1999 / Accepted: July 14, 2000 |
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Keywords: | Heart failure Doppler transmitral flow pattern Cardiac natriuretic peptide Prognosis |
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