A rapid test for B-type natriuretic peptide correlates with falling wedge pressures in patients treated for decompensated heart failure: A pilot study

Objectives: To determine if changes in B-type natriuretic peptide (BNP) levels can accurately reflect acute changes in pulmonary capillary wedge pressure during treatment of decompensated heart failure. Background: Tailored therapy of decompensated congestive heart failure with hemodynamic monitorin...

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Bibliographic Details
Published in:	Journal of cardiac failure 2001-03, Vol.7 (1), p.21-29
Main Authors:	Kazanegra, Radmila, Cheng, Van, Garcia, Alex, Krishnaswamy, Padma, Gardetto, Nancy, Clopton, Paul, Maisel, Alan
Format:	Article
Language:	eng
Subjects:	Aged Atrial Natriuretic Factor - blood Atrial Natriuretic Factor - pharmacology Blood Urea Nitrogen Heart Failure - blood Heart Failure - mortality Heart Failure - physiopathology Humans inotrope left ventricular pressure Male Middle Aged Natriuretic Peptide, Brain neurohormonal NYHA Pilot Projects Prognosis Pulmonary Wedge Pressure - drug effects Pulmonary Wedge Pressure - physiology Survival Analysis Swan-Ganz Time Factors vasodilator
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Summary:	Objectives: To determine if changes in B-type natriuretic peptide (BNP) levels can accurately reflect acute changes in pulmonary capillary wedge pressure during treatment of decompensated heart failure. Background: Tailored therapy of decompensated congestive heart failure with hemodynamic monitoring is controversial. Other than the expense and complications of Swan-Ganz catheters, its use in titration of drug therapy has no conclusive end point. Because BNP reflects both elevated left ventricular pressure and neurohormonal modulation and has a short half-life, we hypothesized that levels of BNP would decline in association with falling wedge pressures. Final BNP levels would perhaps signify a new set point of neuromodulation. Methods and Results: Twenty patients with decompensated New York Heart Association (NYHA) class III-IV congestive heart failure (CHF) undergoing tailored therapy were studied. BNP levels were drawn every 2 to 4 hours for the first 24 hours (active treatment phase) and then every 4 hours for the next 24 to 48 hours (stabilization period). Hemodynamic data was recorded simultaneously. In 15 patients whose wedge pressure responded to treatment in the first 24 hours, there was a significant drop in BNP levels (55%) versus nonresponders (8%). There was a significant correlation between percent change in wedge pressure from baseline per hour and the percent change of BNP from baseline per hour (r = 0.79, P
ISSN:	1071-9164 1532-8414