Can we predict the clinical scenario of acute heart failure based only on NT proBNP rate without using echocardiography?

O. Djebbi 1, R. Jebri 1, H. Mahfoudhi 2, F. Aouini.2, M. Ben Abdellaziz.1, L. Lotfi.1, W. Fehri.2, K. Lamine 1.

Résumé

Background: The acute heart failure (AHF) is a common pattern to seek care in the emergency department (ED). The objective of our study was to investigate the relationship between NT pro-BNP and acute heart failure (AHF) syndrome in the emergency department (ED).
Methods: We conducted a descriptive prospective study over eight months. Were included all patients who presented to the emergency department (ED) with dyspnea and in whom the diagnosis of acute heart failure (AHF) was made. All patients had an NT pro-BNP laboratory test and underwent echocardiography.
Results: One hundred seven patients were included. Mean age was 65 ± 12 years. Sex ratio was 2.34. A clinical scenario CS1 was noted in 28% of cases, CS2 in 36% of cases, CS4 in 16% of cases, CS3 in 12% of cases and CS5 in 8% of cases. Thirty percent of patients had preserved left ventricular ejection fraction (LVEF) with diastolic dysfunction and 70% had a reduced left ventricular ejection fraction (LVEF). Elevated left ventricular filling pressures were found in 95% of patients. Disorders of wall motion in 14% of cases and isolated right heart failure in 12% of cases. The median natriuretic brain peptides (NT pro-BNP) level was higher when left ventricular ejection fraction (LVEF) was preserved: 4073 [410 – 25 550] pg/ml vs2025 [409 – 25 200] pg/ml (p=0,043).
Conclusion: Natriuretic brain peptides level was a good predictor of the clinical scenario CS1 with a cut-off at 5565 pg/ml. Though, the potential clinical applications of B-type natriuretic peptide in AHFS should be more studied.