The effectiveness of emergency cardiac imaging methods in heart failure and its relation with PROBNP

Introduction and Aim: Heart failure is a clinical condition that results from a decrease in the heart's ability to send the required amount of blood to the tissues to meet the oxygen and metabolic needs of the tissues. Heart failure, incidence of it that increases day by day, is a serious health problem resulting in significant morbidity and mortality. Although echocardiography (EKO) is the gold standard in the diagnosis of heart failure, it is a time-consuming, practitioner-dependent and not always accessible method. For this reason, studies on new diagnostic markers for heart failure continue. Type B natriuretic peptide (proBNP) is a diuretic peptide that is produced in the ventricular myocardium but is released into the plasma only in cases of left heart failure, such as increased intraventricular volume, increased wall tension, and increased post-diastolic pressure. Serum proBNP levels in patients with symptoms of heart failure and ejection fraction below 50% in echocardiography are significantly higher than in patients without heart failure. With this study, we aimed to determine the place of FOCUS in the diagnosis of heart failure and its effectiveness in early diagnosis of heart failure in emergency room and to compare the effectiveness of FOCUS, serum proBNP levels and other diagnostic methods in diagnosis of heart failure, and aimed to reduce the time in the emergency room by ensuring that patients with heart failure are diagnosed early in the emergency room. Material and Method: This study was performed as a prospective and cross-sectionally between January 1, 2018 - June 30, 2020, in the Department of Emergency Medicine at Balcalı Hospital with the approval of Çukurova University Faculty of Medicine Ethics Committee. 38 patients aged 18 years or older, who admitted to the Adult Emergency Medicine Service within the specified time period, who were diagnosed with heart failure according to the ESC 2016 guidelines, were included in the study. For the classification of patients, the classification of heart failure according to left ventricular ejection fraction in ESC 2016 guideline was used. Sociodemographic data, vital findings and medical history of the patients, the signs and symptoms, laboratory findings, ECHO, USG, ECG and radiographic findings were collected and recorded in the previously prepared study sheat. Research data was uploaded and analyzed on computer via "SPSS for Windows 22.0". Results: 38 patients were included in the study. The average age of the patients evaluated in the study was 70.34 ± 8.67 years, 26 of the patients (68.4%) were male and 12 were female (31.6%). Chronic medication was used in 97% (n = 37) of the patients. The most common complaint for admitting the emergency room was shortness of breath in 71.1% (n = 27) of patients. The most common physical examination finding in patients was 92.1% (n = 35) ral in the lungs. When the correlation relationship between the proBNP values and ECHO findings of the patients included in the study was examined, it was found that there was a statistically significant negative relationship between the ejection fraction and the proBNP values (r = -0.342, p = 0.035). When the ECHO findings of the patients included in the study were compared according to their BMI values, it was found that there was a statistically significant positive relationship (r = 0.342, p = 0.047) between the BMI and the VCI diameter. There was no statistically significant relationship between VCI diameter and collapse rates and proBNP values (p = 0.581; p = 0.823), but statistically significant levels of VCI collapse rates were found to be <50% in patients with chronic renal disease or asthma / COPD (p= 0.012; p = 0.024). Discussion and Conclussion: In our study, the efficacy and correlation of ECO and serum proBNP levels in the diagnosis of heart failure patients were investigated. A statistically significant negative correlation was found between serum proBNP levels and EF measurements. In addition, it was found that there was a statistically significantly more right ventricular dilatation in patients with previous heart valve disease. It was found that patients with ST change in ECG had statistically significant more proBNP elevation compared to those without ST change in ECG, and patients with ECG in normal sinus rhythm were significantly lower proBNP values than other patients. In addition, in the presence of asthma / COPD or CKD in patients with heart failure, there was a statistically significant relationship between BMI diameter and collapse rates and serum proBNP levels.Clearer data on the correlation relationships between ECO findings and the use of serum proBNP levels in the diagnosis of heart failure in the emergency room can be revealed through studies to be conducted with a larger number of patients. Keywords: Echocardiography, ECHO, ultrasonography, proBNP, heart failure,vena cava inferior, FOCUS, Emergency medicine