Frank L Dini1, Erberto Carluccio2, Fabrizio Montecucco3,4,5, Gian Marco Rosa6, Paolo Fontanive1. 1. Cardiovascular and Thoracic Department, University of Pisa, Pisa, Italy. 2. Divisions of Cardiology, School of Medicine, University of Perugia, Perugia, Italy. 3. First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy. 4. Ospedale Policlinico San Martino, Genoa, Italy. 5. Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy. 6. Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa, Italy.
Abstract
BACKGROUND: Chronic heart failure (HF) is a relevant and growing public health problem. Although the prognosis has recently improved, it remains a lethal disease, with a mortality that equals or exceeds that of many malignancies. Furthermore, chronic HF is costly, representing a large and growing drain on healthcare resources. METHODS: This narrative review is based on the material searched for and obtained via PubMed up to May 2017. The search terms we used were as follows: "heart failure, echocardiography, natriuretic peptides" in combination with "treatment, biomarkers, guidelines." RESULTS: Recent studies have supported the value of natriuretic peptides (NPs) and Doppler echocardiographic biomarkers of increased left ventricular (LV) filling pressures or pulmonary congestion as tools to scrutinize patients with impending clinically overt HF. Therefore, combination of pulsed-wave tissue and blood flow Doppler with NPs appears valuable in guiding HF management in the outpatient setting. In as much as both the echo and the plasma levels of NPs may reflect the presence of fluid overload and elevations of LV filling pressures, integrating NP and echocardiographic biomarkers with clinical findings may help the cardiologist to identify high-risk patients, that is to recognize whether a patient is stable or the condition is likely to evolve into decompensated HF, to optimize treatment, to improve the prognosis and to reduce rehospitalization. CONCLUSION: We discussed the rationale and the clinical significance of combining follow-up echo and NP assessment to guide management of ambulatory patients with chronic HF.
BACKGROUND:Chronic heart failure (HF) is a relevant and growing public health problem. Although the prognosis has recently improved, it remains a lethal disease, with a mortality that equals or exceeds that of many malignancies. Furthermore, chronic HF is costly, representing a large and growing drain on healthcare resources. METHODS: This narrative review is based on the material searched for and obtained via PubMed up to May 2017. The search terms we used were as follows: "heart failure, echocardiography, natriuretic peptides" in combination with "treatment, biomarkers, guidelines." RESULTS: Recent studies have supported the value of natriuretic peptides (NPs) and Doppler echocardiographic biomarkers of increased left ventricular (LV) filling pressures or pulmonary congestion as tools to scrutinize patients with impending clinically overt HF. Therefore, combination of pulsed-wave tissue and blood flow Doppler with NPs appears valuable in guiding HF management in the outpatient setting. In as much as both the echo and the plasma levels of NPs may reflect the presence of fluid overload and elevations of LV filling pressures, integrating NP and echocardiographic biomarkers with clinical findings may help the cardiologist to identify high-risk patients, that is to recognize whether a patient is stable or the condition is likely to evolve into decompensated HF, to optimize treatment, to improve the prognosis and to reduce rehospitalization. CONCLUSION: We discussed the rationale and the clinical significance of combining follow-up echo and NP assessment to guide management of ambulatory patients with chronic HF.
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