Heart, Lung and Circulation
Volume 18, Issue 1 , Pages 38-44, February 2009

Changes in Tissue-Doppler Echocardiographic Assessment of Left Ventricular Filling During NT-proBNP Guided Heart Failure Treatment Titration: A Pilot Study

  • Cara A. Wasywich, MBChB

      Affiliations

    • Green Lane Cardiovascular Service, Auckland City Hospital, Private Bag 92024, Auckland 1031, New Zealand
    • Corresponding Author InformationCorresponding author. Tel.: +64 9 307 4949; fax: +64 9 307 4950.
    • ,
  • Gillian A. Whalley, PhD

      Affiliations

    • Cardiovascular Research Laboratory, Department of Medicine, University of Auckland, Auckland, New Zealand
    • ,
  • Helen A. Walsh, BSc

      Affiliations

    • Cardiovascular Research Laboratory, Department of Medicine, University of Auckland, Auckland, New Zealand
    • ,
  • Greg D. Gamble, MSc

      Affiliations

    • Cardiovascular Research Laboratory, Department of Medicine, University of Auckland, Auckland, New Zealand
    • ,
  • Robert N. Doughty, MD

      Affiliations

    • Cardiovascular Research Laboratory, Department of Medicine, University of Auckland, Auckland, New Zealand

Received 15 August 2007; received in revised form 1 May 2008; accepted 20 July 2008.

Background

Although brain natriuretic peptide (BNP) and E/Ea are closely related in heart failure (HF) patients and may be helpful to guide HF therapy, the response of E/Ea to changes in BNP over several weeks of intensive HF treatment optimisation is unknown. This study was designed to investigate this relationship.

Methods and results

In 17 patients with decompensated HF, treatment was titrated to reduce the NT-proBNP level to <200pg/mL over 10 weeks. Paired NT-proBNP measurements and echocardiograms were performed at two weekly intervals during the study. Treatment titration was associated with a reduction in E/Ea (17.6±6.8S.D. to 13.7±5.0S.D., p=0.018) in keeping with the reduction in NT-proBNP (median 603 [S.E. 561] to 311 [S.E. 235], p=0.045). This relationship remained in those who responded to titration (reduction in NT-proBNP of ≥50%), and those who did not. The overall change in E/Ea was similar to the changes observed in NT-proBNP in each group however there appeared to be temporal differences in the changes in E/Ea and NT-proBNP.

Conclusion

This pilot study demonstrates that the E/Ea decreases after NT-proBNP guided HF therapy. E/Ea may be a complementary target for HF therapy optimisation; this hypothesis should be further evaluated in larger scale randomised trials.

Keywords: Heart failure, Natriuretic peptides, Tissue Doppler, Echocardiography, Treatment

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PII: S1443-9506(08)00818-4

doi:10.1016/j.hlc.2008.07.002

Heart, Lung and Circulation
Volume 18, Issue 1 , Pages 38-44, February 2009

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