Prediction of congestive state in acute and chronic heart failure: The association between NT-proBNP and left atrial strain and its prognostic value. (15th January 2023)

• Record Type: Journal Article
• Authors: Pastore, Maria Concetta; Mandoli, Giulia Elena; Stefanini, Andrea; Ghionzoli, Nicolò; Carrucola, Chiara; De Carli, Giuseppe; Lisi, Matteo; Cavigli, Luna; D'Ascenzi, Flavio; Focardi, Marta; Valente, Serafina; Patti, Giuseppe; Mondillo, Sergio; Cameli, Matteo
• Is Part Of: International journal of cardiology. Volume 371(2023)
• Page Start: 266
• Page End: 272
• Publication Date: 2023-01-15
• Subjects: Heart failure -- Natriuretic peptides -- Left atrial -- Strain -- Speckle tracking -- Echocardiography; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.08.056
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: The relief of congestion is crucial to improve heart failure (HF) patient's quality of life and prognosis. N-terminal-pro-brain natriuretic peptide (NT-proBNP) is a well-known marker of congestion, although with limited specificity. Peak atrial longitudinal strain (PALS) by speckle tracking echocardiography (STE) is an index of intracardiac pressure and HF prognosis. We aimed to determine the association between NT-proBNP and PALS and its prognostic implications in patients with HF. Methods: Patients hospitalized for de-novo or recurrent HF and outpatients with chronic HF were included in this retrospective study. Patients with missing data, previous cardiac surgery, non-feasible STE were excluded. Clinical, laboratory and echocardiographic data were collected. STE was performed on echocardiographic records. Primary endpoint was a combination of all-cause death and HF hospitalization. Results: Overall, 388 patients were included (172 acute HF, 216 chronic HF, mean age = 65 ± 12 years, 37% female). Mean LV ejection fraction = 31 ± 9%. Global PALS showed a significant inverse correlation with NT-proBNP in acute and chronic HF (all p < 0.001). During a median follow-up of 4 years, 180 patients reached the combined endpoint. NT-proBNP (AUC = 0.87) and global PALS (AUC = 0.82) were good predictors of the combined endpoint. Global PALS was the only independent predictor of the combined endpoint. Optimal risk stratification for the composite endpoint was provided combining PALS ≤15% and NTproBNP ≥874.5 ng/l. Conclusions: Global PALS is associated with NT-proBNP in acute and chronic HF and may be used as additional index of congestion to optimize therapeutic management. The combination of global PALS and NT-proBNP could enhance the prognostic stratification of HF. Graphical abstract: Unlabelled Image Highlights: The relief of congestion is one of the main therapeutic targets in heart failure (HF). Left atrial (LA) strain is correlated with NT-proBNP in acute and chronic HF. Speckle tracking echocardiography adds prognostic information to NT-proBNP in HF. The combination of LA strain and NT-proBNP provides optimal risk stratification in HF.