Comparison of echocardiography and plasma B-type natriuretic peptide for monitoring the response to treatment in acute heart failure

AIMS: Comparison of the value of echocardiography and B-type natriuretic peptide (BNP) in monitoring response to treatment in patients admitted for acute heart failure (HF). METHODS AND RESULTS: Ninety-five consecutive patients admitted with acute HF underwent bedside Doppler echocardiography and BNP measurements on admission, after 24 h of intravenous treatment, and at day 7. We then studied the association between the clinical status, the Doppler echocardiographic findings, the BNP measurements and subsequent 60-day adverse outcome (death, resuscitated cardiac arrest, urgent heart transplantation, readmission). On admission and during hospitalisation, relationships were found between plasma BNP and Doppler echocardiographic findings, and between their changes. During a 60 day follow-up, 37 events occurred. Multivariable analysis taking into account clinical factors, Doppler echocardiography and BNP showed that the two best models to predict outcome were (1) early evaluation at day 2 (previous CHF treatment, dobutamine use, relative BNP change during first 24 h) and (2) late evaluation at day 7 (previous CHF treatment, dobutamine use, BNP at day 7). Patients with a decrease in plasma BNP >10% at day 2, or with plasma BNP <300 pg/ml at day 7 had a better outcome than the others (19% versus 65% and 16% versus 72% events, respectively, p<0.0001). CONCLUSIONS: Serial BNP measurements during the treatment of acute HF provide incremental prognostic information over clinical presentation and repetitive echocardiographic examination.