B-type natriuretic peptide levels are not a surrogate marker for invasive hemodynamics during management of patients with severe heart failure

We sought to assess the utility of serial BNP measurements in patients with severe heart failure and attempted to correlate values with invasively derived data. In a retrospective study, we analyzed serial BNP levels in patients receiving hemodynamically guided therapy for severe heart failure and s...

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Bibliographic Details
Published in:The American heart journal 2005-02, Vol.149 (2), p.363-369
Main Authors: O'Neill, J.O., Bott-Silverman, C.E., McRae, A.T., Troughton, R.W., Ng, K., Starling, R.C., Young, J.B.
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Biomarkers - blood
Blood pressure
Cardiology. Vascular system
Catheterization, Swan-Ganz
Catheters
Female
Heart
Heart failure
Heart Failure - blood
Heart Failure - diagnosis
Heart Failure - drug therapy
Heart Failure - physiopathology
Heart failure, cardiogenic pulmonary edema, cardiac enlargement
Heart rate
Hemodynamics
Humans
Intensive care
Male
Medical sciences
Middle Aged
Mortality
Natriuretic Peptide, Brain - blood
Peptides
Pulmonary arteries
ROC Curve
Sensitivity and Specificity
Software
Statistical analysis
Veins & arteries
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Summary:We sought to assess the utility of serial BNP measurements in patients with severe heart failure and attempted to correlate values with invasively derived data. In a retrospective study, we analyzed serial BNP levels in patients receiving hemodynamically guided therapy for severe heart failure and sought correlation with invasively derived data. Thirty-nine patients with New York Heart Association Class III-IV, with an ejection fraction of 35% or less, who had a pulmonary artery catheter inserted for hemodynamically tailored heart failure therapy, were identified and serial BNP measurements reviewed. BNP was estimated on admission, at 12 and 36 hours. Normally distributed variables are expressed as mean ± SD and otherwise as median ± interquartile range. Mean ejection fraction was 16% ± 6%. Mean pulmonary artery occlusion pressures (PAOP) fell with therapy and were 25 ± 7 mmHg, 18 ± 7 mmHg and 19 ± 7 mmHg at admission, 12 hours and 36 hours respectively ( P < 0.05). Median BNP levels fell from 1200 ± 641 to 771 ± 803 at 12 hours and to 805 ± 771 at 36 hours ( P < .001). There was no correlation between BNP and any hemodynamically derived variable. A change in BNP was not associated with a change in PAOP in any individual patient. Only 42% remained alive on medical therapy at 30 days. In patients with severe heart failure, BNP levels do not accurately predict serial hemodynamic changes and do not obviate the need for pulmonary artery catheterization.
ISSN:0002-8703
1097-6744
DOI:10.1016/j.ahj.2004.05.051