Simioniuc Anca, Carluccio Erberto, Ghio Stefano, Rossi Andrea, Biagioli Paolo, Reboldi Gianpaolo, Galeotti Gian Giacomo, Lu Fei, Zara Cornelia, Whalley Gillian, Temporelli Pier Luigi, Dini Frank Lloyd
Cardiovascular and Thoracic Department, University of Pisa, Pisa, Italy.
Divisions of Cardiology, University of Perugia, School of Medicine, Perugia, Italy.
Int J Cardiol. 2016 Dec 1;224:416-423. doi: 10.1016/j.ijcard.2016.09.034. Epub 2016 Sep 18.
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.
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).
Echo and BNP guided management may improve the outcome and reduce worsening of renal function in outpatients with chronic HFrEF.
B型利钠肽（BNP）和超声心动图可能有助于指导慢性心力衰竭（HF）患者的管理。因此，这项回顾性多中心研究的目的是比较射血分数降低的慢性HF门诊患者接受超声心动图和BNP指导或临床驱动方案进行随访的结局和肾功能。
在1137例连续门诊患者中，570例（平均射血分数[EF]=30%）根据左心室充盈压升高的超声多普勒征象和符合HF研究组网络实验室超声（NEBULA）方案的BNP水平进行管理，而567例（平均EF=33%）根据心血管和胸外科HF病房的机构方案进行临床驱动管理。使用倾向评分匹配几个混杂的基线变量，根据治疗策略匹配成对。中位随访时间为37.4个月。倾向匹配后，与临床指导组相比，超声心动图-BNP指导组的死亡发生率较低（风险比[HR]0.45，95%置信区间[CI]：0.30-0.67，p<0.0001），死亡或肾功能恶化发生率较低（HR 0.49，95%CI 0.36-0.67，p<0.0001）。超声心动图-BNP指导组9.8%的患者出现肾功能恶化（血清肌酐升高≥0.3mg/dl），临床评估组为21.4%（p<0.0001）。超声心动图-BNP指导组袢利尿剂的每日剂量未改变，而临床指导组65%的患者剂量增加（p<0.0001）。
超声心动图和BNP指导的管理可能改善慢性射血分数降低的HF门诊患者的结局并减少肾功能恶化。
