© 2008 European Society of Cardiology
Complementary role of bedside Doppler echocardiography to natriuretic peptides levels in the middle range for the diagnosis of acute heart failure
Department of Cardiology, Aubagne Hospital Aubagne, 13400, France E-mail address: sarques{at}ch-aubagne.fr
First, I would like to congratulate the authors for their excellent review which focuses on current clinical applications of natriuretic peptides in the clinical syndrome of heart failure in daily practice [1].
As reported by the experts, a significant proportion of acutely dyspnoeic patients present with natriuretic peptides in the middle range, which makes the diagnosis inconclusive and requires additional scrutiny. Treatment delay has been recently reported to be a significant, independent predictor of in-hospital mortality, along with age, renal failure, severe symptoms and arterial blood pressure [2]. Rapid and accurate diagnosis is desirable in the acute setting, with the aim to early improve the therapeutic care, although low values of natriuretic peptide levels are associated with better prognosis. Therefore, it appears of paramount importance to highlight the complementary role of Doppler echocardiography in the setting of intermediate, inconclusive natriuretic peptides levels, along with clinical and radiographic variables [3]. Doppler echocardiography at bedside offers the ability to provide incremental diagnostic information over natriuretic peptide levels, regardless of left ventricular systolic performance [4]. Particularly, evidence of depressed left ventricular ejection fraction and/or significant increase in left ventricular diastolic pressures readily establishes the diagnosis of congestive heart failure in patients with inconclusive levels of natriuretic peptides [5-8].
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- Maisel A., Mueller C., Adams K. Jr., et al. State of the art: using natriuretic peptide levels in clinical practice. Eur J Heart Fail (2008) 10:824–839. 10.1016/j.ejheart.2008.07.014.
[Abstract/Free Full Text] - Maisel A.S., Peacock W.F., McMullin N., Jessie R., Fonarow G.C., Wynne J., Mills R.M. Timing of immunoreactive B-type natriuretic peptide levels and treatment delay in acute decompensated heart failure: an ADHERE (Acute Decompensated Heart Failure National Registry) analysis. J Am Coll Cardiol (2008) 52:534–540.
[Abstract/Free Full Text] - Strunk A., Bhalla V., Clopton P., et al. Impact of the history of congestive heart failure on the utility of B-type natriuretic peptide in the emergency diagnosis of heart failure: results from the Breathing Not Properly Multinational Study. Am J Med (2006) 119(69):e1–e11.[Medline]
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[Abstract/Free Full Text] - Arques S., Roux E., Sbragia P., Pieri B., Gelisse R., Ambrosi P., Luccioni R. Accuracy of tissue Doppler echocardiography in the diagnosis of new-onset congestive heart failure in patients with levels of B-type natriuretic peptide in the mid-range and normal left ventricular ejection fraction. Echocardiography (2006) 23:627–634.[CrossRef][Web of Science][Medline]
- Huang C.H., Tsai M.S., Hsieh C.C., Wang T.D., Chang W.T., Chen W.J. Diagnostic accuracy of tissue Doppler echocardiography for patients with acute heart failure. Heart (2006) 92:1790–1794.
[Abstract/Free Full Text] - Arques S., Roux E., Sbragia P., Pieri B., Gelisse R., Ambrosi P., Luccioni R. Accuracy of the isovolumic relaxation time in the emergency diagnosis of new-onset congestive heart failure with preserved left ventricular systolic function in the setting of B-type natriuretic peptide levels in the mid-range. Int J Cardiol (2008) 124:400–403.[CrossRef][Web of Science][Medline]
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