Natriuretic Peptide and Clinical Evaluation in the Diagnosis of Heart Failure Hemodynamic Profile: Comparison with Tissue Doppler Echocardiography
Gustavo Luiz Gouvêa de Almeida Junior
Marcelo Iorio Garcia
Fernando Oswaldo Dias Rangel
Ricardo Mourilhe Rocha
Fabricio Braga da Silva
Paula de Castro Carvalho Gorgulho
Sergio Salles Xavier
Figure 2 – Receiver operator characteristics curves for estimating left atrial pressure ≥ 15 mm Hg. Estimates were based on dichotomized variables. CS: clinical score; CR: chest radiography; BNP: B-type natriuretic peptide.
Background: Physical examination and B-type natriuretic peptide (BNP) have been used to estimate hemodynamics and tailor therapy of acute decompensated heart failure (ADHF) patients. However, correlation between these parameters and left ventricular filling pressures is controversial.
Objective: This study was designed to evaluate the diagnostic accuracy of physical examination, chest radiography (CR) and BNP in estimating left atrial pressure (LAP) as assessed by tissue Doppler echocardiogram.
Methods: Patients admitted with ADHF were prospectively assessed. Diagnostic characteristics of physical signs of heart failure, CR and BNP in predicting elevation (> 15 mm Hg) of LAP, alone or combined, were calculated. Spearman test was used to analyze the correlation between non-normal distribution variables. The level of significance was 5%.
Results: Forty-three patients were included, with mean age of 69.9 ± 11.1years, left ventricular ejection fraction of 25 ± 8.0%, and BNP of 1057 ± 1024.21 pg/mL. Individually, all clinical, CR or BNP parameters had a poor performance in predicting LAP ≥ 15 mm Hg. A clinical score of congestion had the poorest performance [area under the receiver operating characteristic curve (AUC) 0.53], followed by clinical score + CR (AUC 0.60), clinical score + CR + BNP > 400 pg/mL (AUC 0.62), and clinical score + CR + BNP > 1000 pg/mL (AUC 0.66).
Conclusion: Physical examination, CR and BNP had a poor performance in predicting a LAP ≥ 15 mm Hg. Using these parameters alone or in combination may lead to inaccurate estimation of hemodynamics. (Arq Bras Cardiol. 2018; 110(3):270-277)
Keywords: Heart Failure; Natriuretic Peptide, Brain; Hemodynamics; Ventricular Function, Left; Echocardiography, Doppler.