Anca Simioniuc1, Erberto Carluccio2, Stefano Ghio3, Andrea Rossi4, Paolo Biagioli2, Gianpaolo Reboldi5, Gian Giacomo Galeotti1, Fei Lu1, Cornelia Zara1, Gillian Whalley6, Pier Luigi Temporelli7, Frank Lloyd Dini8. 1. Cardiovascular and Thoracic Department, University of Pisa, Pisa, Italy. 2. Divisions of Cardiology, University of Perugia, School of Medicine, Perugia, Italy. 3. Cardiovascular and Thoracic Department, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy. 4. Department of Biomedical and Surgical Sciences, Cardiology Section, University of Verona, Verona, Italy. 5. Department of Internal Medicine, University of Perugia, Perugia, Italy. 6. Institute of Diagnostic Ultrasound, Australasian Sonographers Association, Auckland, New Zealand. 7. Division of Cardiology, Fondazione Salvatore Maugeri, IRCCS, Veruno, Italy. 8. Cardiovascular and Thoracic Department, University of Pisa, Pisa, Italy. Electronic address: f.dini@ao-pisa.toscana.it.
Abstract
BACKGROUND: B-type natriuretic peptide (BNP) and echocardiography are potentially useful adjunct to guide management of patients with chronic heart failure (HF).Thus, the aim of this retrospective, multicenter study was to compare outcomes and renal function in outpatients with chronic HF with reduced ejection fraction (HFrEF) who underwent an echo and BNP guided or a clinically driven protocol for follow-up. METHODS AND RESULTS: In 1137 consecutive outpatients, management was guided according to echo-Doppler signs of elevated left ventricular filling pressure and BNP levels conforming to the protocol of the Network Labs Ultrasound (NEBULA) in HF Study Group in 570 (mean EF=30%), while management was clinically driven based on the institutional protocol of the HF Unit of the Cardiovascular and Thoracic Department in 567 (mean EF=33%). Propensity score, matching several confounding baseline variables, was used to match pairs based on treatment strategy. The median follow-up was 37.4months. After propensity matching, a lower incidence of death (HR 0.45, 95%CI: 0.30-0.67, p<0.0001), and death or worsening renal function (HR 0.49, 95%CI 0.36-0.67, p<0.0001) was apparent in echo-BNP-guided group compared to clinically-guided group. Worsening of renal function (≥0.3mg/dl increase in serum creatinine) was observed in 9.8% of echo-BNP-guided group and in 21.4% of clinical assessed group (p<0.0001). The daily dose of loop diuretics did not change in echo-BNP-guided group, while it increased in 65% of patients in clinically-guided group (p<0.0001). CONCLUSIONS: Echo and BNP guided management may improve the outcome and reduce worsening of renal function in outpatients with chronic HFrEF.
BACKGROUND:B-type natriuretic peptide (BNP) and echocardiography are potentially useful adjunct to guide management of patients with chronic heart failure (HF).Thus, the aim of this retrospective, multicenter study was to compare outcomes and renal function in outpatients with chronic HF with reduced ejection fraction (HFrEF) who underwent an echo and BNP guided or a clinically driven protocol for follow-up. METHODS AND RESULTS: In 1137 consecutive outpatients, management was guided according to echo-Doppler signs of elevated left ventricular filling pressure and BNP levels conforming to the protocol of the Network Labs Ultrasound (NEBULA) in HF Study Group in 570 (mean EF=30%), while management was clinically driven based on the institutional protocol of the HF Unit of the Cardiovascular and Thoracic Department in 567 (mean EF=33%). Propensity score, matching several confounding baseline variables, was used to match pairs based on treatment strategy. The median follow-up was 37.4months. After propensity matching, a lower incidence of death (HR 0.45, 95%CI: 0.30-0.67, p<0.0001), and death or worsening renal function (HR 0.49, 95%CI 0.36-0.67, p<0.0001) was apparent in echo-BNP-guided group compared to clinically-guided group. Worsening of renal function (≥0.3mg/dl increase in serum creatinine) was observed in 9.8% of echo-BNP-guided group and in 21.4% of clinical assessed group (p<0.0001). The daily dose of loop diuretics did not change in echo-BNP-guided group, while it increased in 65% of patients in clinically-guided group (p<0.0001). CONCLUSIONS: Echo and BNP guided management may improve the outcome and reduce worsening of renal function in outpatients with chronic HFrEF.
Authors: Frank Lloyd Dini; Anca Simioniuc; Erberto Carluccio; Stefano Ghio; Andrea Rossi; Paolo Biagioli; Gianpaolo Reboldi; Gian Giacomo Galeotti; Fei Lu; Cornelia Zara; Gillian Whalley; Pier Luigi Temporelli Journal: Data Brief Date: 2016-11-09
Authors: Gani Bajraktari; Nicola Riccardo Pugliese; Andreina D'Agostino; Gian Marco Rosa; Pranvera Ibrahimi; Luan Perçuku; Mario Miccoli; Gian Giacomo Galeotti; Iacopo Fabiani; Roberto Pedrinelli; Michael Henein; Frank L Dini Journal: Cardiol Res Pract Date: 2018-09-30 Impact factor: 1.866