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BNP versus NT-proBNP for echocardiographic and hemodynamic parameters prediction in heart transplanted patients
Session:
Comunicações Orais (Sessão 10) - Insuficiência Cardíaca 1 - Parâmetros de Avaliação e Prognóstico
Speaker:
Francisco Barbas de Albuquerque
Congress:
CPC 2022
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.3 Chronic Heart Failure – Diagnostic Methods
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Francisco Barbas de Albuquerque; Ana Raquel Carvalho Santos; António Valentim Gonçalves; Rita Ilhão Moreira; Tiago Pereira-Da-Silva; Valdemar Gomes; Rui Soares; Lídia de Sousa; Rui Cruz Ferreira
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Background</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Invasive right-heart (RH) catheterization for hemodynamic assessment and transthoracic echocardiography (TTE) for functional and structural evaluation are used on heart transplanted (HT) patients clinical approach. In this population, it is still unclear whether brain natriuretic peptide (BNP) and N-terminal-pro-hormone BNP (NT-proBNP) plasma levels predict unfavorable hemodynamic and TTE parameters. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Aim</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">To assess whether BNP and NT-proBNP can predict hemodynamic and TTE parameters in the HT population.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Retrospective analysis of consecutive HT patients submitted to RH catheterization and TTE between February 2016 and November 2021. Plasma BNP and NT-proBNP, measured at the same day, were used to determine whether unfavorable hemodynamic and TTE characteristics might be predicted using the area under the curve (AUC) analysis of Receiver Operating Characteristic curve (SPSS®).</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A total of 127 RH catheterization and TTE were performed in the study period. Mean age was 49.5 years, mean left ventricular ejection fraction was 57.7 ± 10.2%, BNP 808 ± 984pg/mL and NT-pro BNP 4221 ± 8418pg/mL. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">AUC results of BNP and NT-proBNP values for TTE and RH hemodynamic parameters prediction are described in Table 1. BNP, but not NT-proBNP, was significantly increased in patients with pulmonary capillary wedge pressure (PCWP) ≥ 15 mmHg (<em>p</em><0.001), central venous pressure (CVP) ≥ 8 mmHg (<em>p</em>=0.012), cardiac index < 2.5 L/min/m<sup>2</sup> (<em>p</em><0.001), cardiac power output < 0.6 (<em>p</em>=0.003) on RH catheterization and left ventricular ejection fraction (LVEF) < 50% (<em>p</em>=0.013) on TTE. Both BNP and NT-proBNP were significantly associated with mean pulmonary arterial pressure (mPAP) ≥ 20 mmHg (<em>p</em>=0.001 and <em>p</em>=0.003, respectively) on RH catheterization and systolic PAP > 30 mmHg as estimated by TTE (<em>p</em>=0.031 and <em>p</em>=0.012, respectively).</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">BNP > 680 pg/mL had a sensitivity (S) of 81% and specificity (Sp) of 70% to predict PCWP ≥ 15 mmHg, a S of 79% and a Sp of 73% for mPAP ≥ 20mmHg and a S of 70% and Sp of 50% for CVP ≥ 8 mmHg.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conclusion</span></span></p> <p><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">In the HT population, BNP was significantly associated with several hemodynamic parameters while NT-proBNP was not. In an era where many hospitals are replacing the use of BNP for NT-proBNP to follow Heart Failure patients using Sacubitril-Valsartan, physicians might consider these findings important to their clinical practice assessing HT patients</span></span></p>
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