Echo and natriuretic peptide guided therapy improves outcome and reduces worsening renal function in systolic heart failure: An observational study of 1137 outpatients

Simioniuc, Anca; Carluccio, Erberto; Ghio, Stefano; Rossi, Andrea; Biagioli, Paolo; Reboldi, Gianpaolo; Galeotti, Gian Giacomo; Lu, Fei; Zara, Cornelia; Whalley, Gillian A.; Temporelli, Pier Luigi; Dini, Frank Lloyd

doi:10.1016/j.ijcard.2016.09.034

Cited by 30 publications

(16 citation statements)

References 32 publications

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“…The value of integrated NPs and echo‐guided management of outpatients with chronic HF can be established when this strategy will be prospectively compared with the standard of care . In a recent retrospective study, we observed a greater survival benefit in patients in the echo‐ and BNP‐guided group than in a clinically guided group (Figure ). This finding was associated with a better management of renal function (Table ).…”

Section: Combining Echo and Natriuretic Peptides During Follow‐upmentioning

confidence: 85%

“…As renal dysfunction is known to be one of the most predictive markers of adverse outcomes in chronic HF, guiding HF care by means of echo and NPs, such as BNP, seems valuable in order to reduce the patient's risk . Moreover, differently from patients whose management was based on echo and BNP, prescriptions of ACE inhibitors significantly decreased in the clinically guided group, and these patients were less likely to be treated with cardiac resynchronization therapy (Table ) . The latter findings likely indicate that the combination of echo with NPs may effectively contribute to the optimization of guideline adherence for both pharmacological and device therapies …”

Section: Combining Echo and Natriuretic Peptides During Follow‐upmentioning

confidence: 99%

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Combining echo and natriuretic peptides to guide heart failure care in the outpatient setting: A position paper

Dini

Carluccio

Montecucco

et al. 2017

Eur J Clin Investigation

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Section: Combining Echo and Natriuretic Peptides During Follow‐upmentioning

confidence: 85%

Section: Combining Echo and Natriuretic Peptides During Follow‐upmentioning

confidence: 99%

Combining echo and natriuretic peptides to guide heart failure care in the outpatient setting: A position paper

Dini

Carluccio

Montecucco

et al. 2017

Eur J Clin Investigation

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“…In addition to echo Doppler variables that allow estimation of LVFP, that is, E / e ′ and EDT, LUS may be utilized for the prediction of decompensated HF [ 25 ]. The ability to distinguish stable from unstable HF patients may be refined by the concomitant assessment of NP circulating levels and their variations over time [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Echo- and B-Type Natriuretic Peptide-Guided Follow-Up versus Symptom-Guided Follow-Up: Comparison of the Outcome in Ambulatory Heart Failure Patients

Bajraktari

Pugliese

D’Agostino

et al. 2018

Cardiology Research and Practice

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Recent European Society of Cardiology and American Heart Association/American College of Cardiology Guidelines did not recommend biomarker-guided therapy in the management of heart failure (HF) patients. Combination of echo- and B-type natriuretic peptide (BNP) may be an alternative approach in guiding ambulatory HF management. Our aim was to determine whether a therapy guided by echo markers of left ventricular filling pressure (LVFP), lung ultrasound (LUS) assessment of B-lines, and BNP improves outcomes of HF patients. Consecutive outpatients with LV ejection fraction (EF) ≤ 50% have been prospectively enrolled. In Group I (n=224), follow-up was guided by echo and BNP with the goal of achieving E-wave deceleration time (EDT) ≥ 150 ms, tissue Doppler index E/e′ < 13, B-line numbers < 15, and BNP ≤ 125 pg/ml or decrease >30%; in Group II (n=293), follow-up was clinically guided, while the remaining 277 patients (Group III) did not receive any dedicated follow-up. At 60 months, survival was 88% in Group I compared to 75% in Group II and 54% in Group III (χ2 53.5; p < 0.0001). Survival curves exhibited statistically significant differences using Mantel–Cox analysis. The number needed to treat to spare one death was 7.9 (Group I versus Group II) and 3.8 (Group I versus Group III). At multivariate Cox regression analyses, major predictors of all-cause mortality were follow-up E/e′ (HR: 1.05; p=0.0038) and BNP >125 pg/ml or decrease ≤30% (HR: 4.90; p=0.0054), while BNP > 125 pg/ml or decrease ≤30% and B-line numbers ≥15 were associated with the combined end point of death and HF hospitalization. Evidence-based HF treatment guided by serum biomarkers and ultrasound with the goal of reducing elevated BNP and LVFP, and resolving pulmonary congestion was associated with better clinical outcomes and can be valuable in guiding ambulatory HF management.

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“…Supplementary Table 1 shows the characteristics of the study groups. Supplementary Table 2 describes the data on diuretic use (furosemide dose) and the changes in renal function [1].…”

Section: Datamentioning

confidence: 99%

“…Value of the data Echo and BNP guided HF care can provide a tailored approach to the diuretic treatment [1].This strategy can prevent worsening renal function in chronic HF and, thus, may impact patients’ survival [2], [3].…”

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confidence: 99%

Echo and BNP serial assessment in ambulatory heart failure care: Data on loop diuretic use and renal function

et al. 2016

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We compared the follow-up data on loop diuretic use and renal function, as assessed by serum creatinine levels, and the estimated glomerular filtration rate (eGFR), of two groups of consecutive ambulatory HF patients: 1) the clinically-guided group, in which management was clinically driven based on the institutional protocol of the HF Unit of the Cardiovascular and Thoracic Department of Pisa (standard of care) and 2) the echo and B-type natriuretic peptide (BNP) guided group (patients conforming to the protocol of the Network Labs Ultrasound (NEBULA) in HF Study Group: Pisa, Perugia, Pavia; Verona, Auckland, and Veruno), in which therapy was delivered according to the serial assessment of BNP and echocardiography. Patients whose follow-up was based on standard of care had a significant higher prevalence of worsening renal function, that was likely related to higher diuretic dosages, whilst, a better management of renal function was observed in the echo-BNP-guided group. The data is related to “Echo and natriuretic peptide guided therapy improves outcome and reduces worsening renal function in systolic heart failure: An observational study of 1137 outpatients” (A. Simioniuc, E. Carluccio, S. Ghio, A. Rossi, P. Biagioli, G. Reboldi, G.G. Galeotti, F. Lu, C. Zara, G. Whalley, P.G. Temporelli, F.L. Dini, 2016; K.J. Harjai, H.K. Dinshaw, E. Nunez, M. Shah, H. Thompson, T. Turgut, H.O. Ventura, 1999; A. Ahmed, A. Husain, T.E. Love, G. Gambassi, L.J. Dell׳Italia, G.S. Francis, M. Gheorghiade, R.M. Allman, S. Meleth, R.C. Bourge, 2006) [1], [2], [3].

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Echo and natriuretic peptide guided therapy improves outcome and reduces worsening renal function in systolic heart failure: An observational study of 1137 outpatients

Cited by 30 publications

References 32 publications

Combining echo and natriuretic peptides to guide heart failure care in the outpatient setting: A position paper

Combining echo and natriuretic peptides to guide heart failure care in the outpatient setting: A position paper

Echo- and B-Type Natriuretic Peptide-Guided Follow-Up versus Symptom-Guided Follow-Up: Comparison of the Outcome in Ambulatory Heart Failure Patients

Echo and BNP serial assessment in ambulatory heart failure care: Data on loop diuretic use and renal function

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