PMID- 11264546
OWN - NLM
STAT- MEDLINE
DCOM- 20010521
LR  - 20071115
IS  - 1071-9164 (Print)
IS  - 1071-9164 (Linking)
VI  - 7
IP  - 1
DP  - 2001 Mar
TI  - A rapid test for B-type natriuretic peptide correlates with falling wedge 
      pressures in patients treated for decompensated heart failure: a pilot study.
PG  - 21-9
AB  - 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 <.05). When the wedge pressure was kept at a 
      stable, low level during the stabilization phase, BNP levels continued to fall 
      another 37% (937 +/- 140 pg/mL at 24 hours to 605 +/- 128 pg/mL). Patients who 
      died (n = 4) had higher final BNP levels (1,078 +/- 123 pg/mL v 701 +/- 107 
      pg/mL). CONCLUSIONS: The data suggest that rapid testing of BNP may be an 
      effective way to improve the in-hospital management of patients admitted with 
      decompensated CHF. Although BNP levels will not obviate the need for invasive 
      hemodynamic monitoring, it may be a useful adjunct in tailoring therapy to these 
      patients.
FAU - Kazanegra, R
AU  - Kazanegra R
AD  - Division of Cardiology, Department of Medicine, Veteran's Affairs Medical Center, 
      San Diego, California 92161, USA.
FAU - Cheng, V
AU  - Cheng V
FAU - Garcia, A
AU  - Garcia A
FAU - Krishnaswamy, P
AU  - Krishnaswamy P
FAU - Gardetto, N
AU  - Gardetto N
FAU - Clopton, P
AU  - Clopton P
FAU - Maisel, A
AU  - Maisel A
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Card Fail
JT  - Journal of cardiac failure
JID - 9442138
RN  - 114471-18-0 (Natriuretic Peptide, Brain)
RN  - 85637-73-6 (Atrial Natriuretic Factor)
SB  - IM
MH  - Aged
MH  - Atrial Natriuretic Factor/*blood/pharmacology
MH  - Blood Urea Nitrogen
MH  - Heart Failure/blood/mortality/*physiopathology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Natriuretic Peptide, Brain
MH  - Pilot Projects
MH  - Prognosis
MH  - Pulmonary Wedge Pressure/drug effects/*physiology
MH  - Survival Analysis
MH  - Time Factors
EDAT- 2001/03/27 10:00
MHDA- 2001/05/25 10:01
CRDT- 2001/03/27 10:00
PHST- 2001/03/27 10:00 [pubmed]
PHST- 2001/05/25 10:01 [medline]
PHST- 2001/03/27 10:00 [entrez]
AID - S1071-9164(01)85084-3 [pii]
AID - 10.1054/jcaf.2001.23355 [doi]
PST - ppublish
SO  - J Card Fail. 2001 Mar;7(1):21-9. doi: 10.1054/jcaf.2001.23355.