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Optimizing Management of Heart Failure by Using Echo and Natriuretic Peptides in the Outpatient Unit

Frank Lloyd Dini1,2, Gani Bajraktari3,4, Cornelia Zara5

  • 1Cardiovascular and Thoracic Department, University of Pisa, Pisa, Italy. f.dini@ao-pisa.toscana.it.

Advances in Experimental Medicine and Biology
|January 29, 2018
PubMed

Insights

Monitoring natriuretic peptides (NPs) and echocardiography can help manage chronic heart failure (HF). This approach aids in identifying patients at high risk for worsening HF, improving patient-centered follow-up care.

Area of Science:

  • Cardiology
  • Internal Medicine

Background:

  • Chronic heart failure (HF) presents a significant public health challenge, marked by high morbidity, mortality, and healthcare expenditures.
  • Elevated left ventricular (LV) filling pressures and fluid overload, often indicated by increased natriuretic peptides (NPs), precipitate over 90% of HF hospitalizations.
  • Persistently abnormal LV filling pressures and rising NP levels are recognized indicators of poor prognosis in HF patients.

Purpose of the Study:

  • To evaluate the utility of combining natriuretic peptide (NP) measurements with echocardiographic biomarkers for guiding ambulatory heart failure (HF) management.
  • To assess the potential of these combined methods in distinguishing stable HF patients from those at high risk of decompensation.

Main Methods:

  • Utilizing serial natriuretic peptide (NP) measurements.
  • Employing Doppler echocardiographic biomarkers, including pulsed-wave blood-flow and tissue Doppler, to assess elevated LV filling pressures.
  • Integrating clinical findings, BNP levels, and echocardiography for patient-centered follow-up care.

Main Results:

  • Recent studies indicate the value of serial NP measurements and echocardiographic biomarkers in identifying patients with impending overt HF.
  • The combination of echocardiography (including pulsed-wave and tissue Doppler) and NP measurements shows promise in HF management.
  • These integrated approaches can potentially differentiate stable patients from those at high risk of HF decompensation.

Conclusions:

  • Combining echocardiographic assessments with natriuretic peptide (NP) measurements offers a valuable strategy for managing ambulatory heart failure (HF).
  • This integrated approach supports a shift from symptom-guided care to more precise, patient-centered follow-up, focusing on clinical findings, BNP, and echocardiography.
  • These methods are potentially useful for risk stratification, distinguishing patients at high risk of decompensation.

Keywords:
Cardiac outputDiastolic dysfunctionEchocardiographyEjection fractionHeart failureHemodynamic profilesNatriuretic peptidesPrognosisPulmonary capillary wedge pressure

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