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Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.  Labels: OBJECTIVE, METHODS, RESULTS. Meshes: Aged, Blood Flow Velocity, Echocardiography, Doppler, Color, Female, Follow-Up Studies, Heart Failure, Humans, Immunoassay, Luminescent Measurements, Male, Mitral Valve, Natriuretic Peptide, Brain, Peptide Fragments, Prognosis, Prospective Studies, Protein Precursors, Pulmonary Wedge Pressure, ROC Curve, Severity of Illness Index, Ventricular Pressure.
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Does non-invasive tissue Doppler imaging pulmonary capillary wedge pressure measurement improve NT-proBNP prognostic value in heart failure? Context: The aim of the present study was to investigate whether the improvement of pulmonary capillary wedge pressure (PCWP) non-invasively assessed with tissue Doppler imaging is able to predict prognosis and cardiac-related mortality in patients with heart failure (HF), as previously demonstrated for NT-proBNP. We prospectively studied 23 patients (74 +/- 10 y; 17 M, 6 F) with acute HF. NT-proBNP and PCWP were measured at admission and discharge. NT-proBNP concentrations were determined by a chemiluminescent immunoassay kit. PCWP was assessed using the ratio of transmitral E velocity to the early diastolic mitral annulus velocity (E'), with the formula PCWP = 1.9 + 1.24 (E/E'). Patients were divided in two groups according to the clinical end-point based on cardiac death and hospital readmission for HF. After a mean follow-up of 230 days, 10 patients reached the end-point (group A), while 13 patients resulted event-free (group B). In group B, NT-proBNP values significantly decreased (3816 +/- 7424 vs. 6799 +/- 10537 pg/mL, P < 0.01) and PCWP improved (17 +/- 7 vs. 23 +/- 12 mmHg, P < 0.01). The decrease in both NT-proBNP and PCWP values was able to identify the majority of patients (77%) with an event-free survival at follow-up, whereas 70% of patients who reached the end-point had discordant changes in NT-proBNP and PCWP (chi2 = 5.06, P < 0.05).
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The combination of a biochemical marker such as NT-proBNP and a new indicator of LV filling pressure (E/E') allows to estimate the prognostic impact of standard medical therapy even in a small group of HF patients. Final Decision: yes