Peptídeos natriuréticos no prognóstico de insuficiência cardíaca congestiva

Abstract

Decompensated congestive heart failure (CHF) is a clinical syndrome often characterized by elevated left ventricular fi lling pressures (LVEDP). Therapy for decompensated CHF aims at normalizing fi lling pressures and thereby improves both symptoms and outcomes. However, therapy guided by direct measurements of fi lling pressure is not practical in most patients, focusing attention on non-invasive surrogate measures of LVEDP for tailoring of heart failure therapy.Natiruretic peptide levels (NP) are closely correlated with LVEDP, which is consistently elevated in decompensated heart failure. In the absence of acute mitral regurgitation and fl ash pulmonary edema, and in the presence of volume overload, NP levels are a useful indication of pulmonary capillary wedge pressure (PCWP). In a study by Kazenegra et al, patients admitted for decompensated CHF had BNP levels and hemodynamic measurements taken every 2 hours for the fi rst 24 hours and every four hours for the next 24-48 hours. PCWP showed a decrease from 33 to 25 mmHg over the fi rst 24 hours, while BNP levels decreased from 1472 to 670 pg/ml. However, no change in BNP was noted in patients with end-stage heart failure, even as wedge pressures dropped