Guided therapy in patients with acute heart failure: left ventricular diastolic filling pattern and NT-proBNP

Abstract

Aim: N-terminal pro B-type natriuretic peptide has been commonly used in acute heart failure. We investigated whether the Doppler transmitral flow parameters on admission and discharge offer a useful guide like N-terminal pro B-type natriuretic peptide levels in acute heart failure. Material and Method: This study with a prospective randomized design included 57 patients admitted to the emergency department between October 2019 and March 2020. All patients had New York Heart Association class IV, had sinus rhythm, and were diagnosed previously with dilate cardiomyopathy. The left ventricular diastolic filling pattern during admission and discharge was evaluated in all patients using transthoracic echocardiography. N-terminal pro B-type natriuretic peptide levels were analyzed on admission and discharge to compare the left ventricular filling pattern. Results: The average age of the patients was 64.94±5.56 years. During admission, the left ventricular filling pattern of all patients was of restrictive type (type III), whereas during discharge, 46 patients had abnormal relaxation (type I) and 11 patients had pseudonormal (type II) filling pattern. N-terminal pro B-type natriuretic peptide levels were 8004.75±743 pg/mL and 1645.17±104.58 pg/mL during admission and discharge, respectively. The mean e/e’ ratio of the patients was 14.83±0.25 and 7.70±0.14 and E/A ratio was 2.51±0.35 and 1.42±0.33 during admission and discharge, respectively. N-terminal pro B-type natriuretic peptide levels with regard to the mitral filling pattern were different during discharge. The N-terminal pro B-type natriuretic peptide level with an abnormal relaxation pattern was 1440.43±144.75 pg/mL and that with a pseudonormal pattern was 1957.60±64.00 pg/mL (p=0.003). Conclusion: Our study demonstrated that the left ventricular filling pattern successfully guided in acute heart failure therapy, similar to N-terminal pro B-type natriuretic peptide -guided therapy.