Evaluation of changes in brain natriuretic peptide levels and echocardiographic parameters by heart failure treatment in patients admitted for decompensated heart failure

Introduction and purpose: The worldwide prevalence and incidence rates of heart failure are approaching epidemic proportions, as evidenced by the relentless increase in the number of heart failure hospitalizations, the growing number of heart failure-attributable deaths, and the spiraling cost associated with the care of heart failure patients. Worlwide, heart failure affects nearly 23 million people. Estimate of the prevalence of symptomatic heart failure in the general European population are similar to those in the United States and range from 0,4 to 2 percent. The prevelance of heart failure follows an exponential pattern, rising with age, and affects 6 to 10 percent people older than 65 years. The aim of this study is to investigate the correlation between echocardiographic parameters and plasma BNP levels and their changes in patients admitted for decompensated heart failure by treatment.Method: A total of 30 patients older than 18 years old and admitted to the Cardiology Department, Dokuz Eylul Universty Medical Faculty Hospital with the diagnosis of decompensated heart failure and performed TTE and measured plasma BNP levels before and after treatment from June 2011 to March 2012 were included in this study. We investigated the correlation between echocardiographic parameters and plasma BNP level and changes of these parameters by heart failure treatment.Results: Heart failure etiology was ischemic origin in 29 patients (96,7 %) and non-ischemic origin in one patient (3,3%). We found significant correlation between the change in BNP level and left atrial diameter and left atrial area.There was statistically significant correlation between changes in BNP levels and LV E wave amplitude (p=0,003 r=0,522) and E/Em ratio (early diastolic wave / early diastolic myocardial motion) measured from lateral and medial mitral annulus (p: <0,0001, r=0,737; p: <0,0001, r=0,765, respectively). Systolic mitral annular velocity measured with tissue Doppler from lateral mitral annulus has significant negative correlation with changes in BNP levels. We did not find significant correlation between BNP change and parameters derived from right ventricle standart Doppler echocardiography and tissue Doppler echocardiography.Conclusion: Especially in advanced heart failure patients because of increased basal BNP levels secondary to enlargement of left ventricle dimensions, BNP cut-off values are not trustable to reflect increased filling pressure and volume overload. Brain natriuretic peptide is a laboratory parameter which is affected by age, renal function, neurohormonal state, LV geometry, left atrial dimensions, diastolic functions and right ventricle functions. This trial showed that single measurement of plasma BNP levels and echocardiographic parameters is not enough for clinical evaluation of a patient but serial measurements of plasma BNP levels and changes of left atrial dimensions, LV E/Em, LV E wave velocity, LV and Sm parameters measured with serial echocardiography can be used to evaluate clinical improvement and worsening.