PMID- 18361212
OWN - NLM
STAT- MEDLINE
DCOM- 20080417
LR  - 20161124
IS  - 1122-0643 (Print)
IS  - 1122-0643 (Linking)
VI  - 68
IP  - 3
DP  - 2007 Sep
TI  - [BNP-guided therapy optimizes the timing of discharge and the medium term risk 
      stratification in patients admitted for congestive heart failure].
PG  - 154-64
AB  - BACKGROUND: Congestive heart failure (HF) is one of the most important cause of 
      hospitalizations and is associated with high cost. Despite a consistent body of 
      data demonstrating the benefits of drug therapy in HF, persistently high rates of 
      readmission, especially within six months of discharge, continue to be 
      documented. Neurohormonal activation characterizes the disease; plasma brain 
      natriuretic peptide (BNP), is correlated with the severity of left ventricular 
      dysfunction and relates to outcome. OBJECTIVE: The aim of the study was to 
      evaluate if plasma levels of BNP would provide an index to guide drug treatment 
      and to predict medium-term prognosis in HF patients (pts) after hospital 
      discharge. METHODS AND RESULTS: We evaluated 200 consecutive pts (age 77 +/- 10 
      (35-96) years, 49% male versus 51% female) hospitalized for HF (DRG 127). 
      Standard echocardiography was performed and left ventricular systolic/diastolic 
      function was assessed; plasma BNP levels were measured with a rapid point-of-care 
      assay (Triage BNP Test, Biosite Inc, San Diego, CA) on days 1 and after initial 
      treatment. Using a cut-off of 240 pg/ml and/or changes in plasma BNP (days 2-3 
      after admission), 2 groups were identified: the low BNP group-responders (n = 68, 
      BNP < 240 pg/ml and/or > or = 30% reduction) and the high BNP group-non 
      responders (n = 132, BNP > or = 240 pg/ml and/or < 30% reduction). The high BNP 
      group showed a different pattern of clinical variables according to the severity 
      of the disease New York Heart Association (NYHA) functional class, left 
      ventricular ejection fraction, ischemic etiology and age. A sustained elevation 
      of plasma BNP (> 240 pg/mL) indicated the presence of a clinical unstable 
      condition requiring further intervention whereas pts with low BNP values were 
      discharged after 24 hours. During a mean follow-up period of 3 months, there were 
      62 cardiac events, including 15 cardiac deaths, 22 readmissions for worsening 
      heart failure and 25 clinical decompensation requiring diuretic treatment. The 
      incidence of clinical events was significantly greater in pts with higher levels 
      of BNP (admission and discharge) than in those with lower levels (42% vs. 10%) 
      and plasma values > 500 pg/ml identified a subgroup at high risk of death. 
      CONCLUSIONS: The influence of BNP in the clinical course and prognosis of 
      patients hospitalized for HF has not been studied. After initial treatment pts 
      need to be risk stratified by means of the BNP test, to guide further management 
      and to identify subjects with poor prognosis. An aggressive therapeutic and 
      follow-up strategy may be justified for pts with high BNP levels and/or no 
      changes after hospital admission for worsening HF. The changes in plasma BNP 
      level at discharge were significantly related to cardiac events.
FAU - Valle, Roberto
AU  - Valle R
AD  - Centro per lo scompenso cardiaco, Unita operativa complessa di Cardiologia, 
      Ospedale civile, San Dona di Piave. robertovalle@libero.it
FAU - Aspromonte, Nadia
AU  - Aspromonte N
FAU - Carbonieri, Emanuele
AU  - Carbonieri E
FAU - De Michele, Giorgio
AU  - De Michele G
FAU - Di Tano, Giuseppe
AU  - Di Tano G
FAU - Giovinazzo, Prospero
AU  - Giovinazzo P
FAU - Cioe, Roberta
AU  - Cioe R
FAU - Di Giacomo, Tiziana
AU  - Di Giacomo T
FAU - Milani, Loredano
AU  - Milani L
FAU - Noventa, Federica
AU  - Noventa F
FAU - Chiatto, Mario
AU  - Chiatto M
LA  - ita
PT  - Journal Article
TT  - La terapia guidata dal BNP consente l'ottimizzazione del timing di dimissione e 
      la stratificazione del rischio a medio termine nel paziente ricoverato per 
      scompenso cardiaco.
PL  - Italy
TA  - Monaldi Arch Chest Dis
JT  - Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace
JID - 9307314
RN  - 114471-18-0 (Natriuretic Peptide, Brain)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - Heart Failure/*blood/diagnostic imaging/*drug therapy
MH  - Humans
MH  - Length of Stay
MH  - Male
MH  - Middle Aged
MH  - Natriuretic Peptide, Brain/*blood
MH  - Patient Readmission
MH  - Predictive Value of Tests
MH  - Prognosis
MH  - Risk Assessment
MH  - Ultrasonography
MH  - Ventricular Dysfunction, Left/*blood/diagnostic imaging
EDAT- 2008/03/26 09:00
MHDA- 2008/04/18 09:00
CRDT- 2008/03/26 09:00
PHST- 2008/03/26 09:00 [pubmed]
PHST- 2008/04/18 09:00 [medline]
PHST- 2008/03/26 09:00 [entrez]
AID - 10.4081/monaldi.2007.448 [doi]
PST - ppublish
SO  - Monaldi Arch Chest Dis. 2007 Sep;68(3):154-64. doi: 10.4081/monaldi.2007.448.