Significance of predischarge BNP on one-year outcome in decompensated heart failure--comparative study with echo-Doppler indexes.

BACKGROUND

Cardiac natriuretic peptides and echo-Doppler indexes are important as prognostic indicators of congestive heart failure (CHF). However, differences between etiologies have not been fully investigated. This study aimed to assess the prognostic value of transmitral flow (TMF) and B-type natriuretic peptide (BNP) on admission or predischarge in patients with acutely decompensated CHF of ischemic and nonischemic etiologies.

METHODS AND RESULTS

We studied 52 patients with chronic CHF, 31 with old myocardial infarction (OMI), and 21 with idiopathic dilated cardiomyopathy (DCM), admitted for emergency acute decompensation. Patients underwent echo-Doppler study and measurement of plasma BNP on admission and predischarge. The combined index of BNP with echo-Doppler indexes were calculated. Pulmonary capillary wedge pressure (PCWP) and cardiac index were measured on admission. All were followed for 1 year, and those rehospitalized (R group) were compared with those with a stable clinical course (S group). TMF and BNP on admission were similar between DCM and OMI groups. During follow up, 9 with OMI and 10 with DCM were rehospitalized. There were no statistical differences in TMF or BNP levels on admission between the R and S groups. However, the predischarge BNP level was significantly higher in the R group than in the S. Kaplan-Meier curves revealed the influence of predischarge BNP on prognosis.

CONCLUSION

Predischarge BNP, not BNP on admission, levels are considered predictive of rehospitalization for decompensation within a year. There were no differences between BNP and echo-Doppler indexes with regard to the CHF etiology.