Prognostic value of Doppler transmitral flow patterns and cardiac natriuretic peptides in patients with chronic congestive heart failure admitted forepisodes of acute decompensation

This study was designed to determine whether the restrictive filling transm itral flow velocity pattern is associated with increased plasma levels of a trial natriuretic peptide (ANP) and brain natriuretic peptide (BNP). It was also designed to evaluate the prognostic value of these parameters from pa tients with chronic congestive heart failure (CHF) admitted for episodes of acute decompensation. We performed Doppler echocardiography, measured plas ma levels of ANP and BNP in 33 patients at the time of admission, and asses sed the subsequent cardiac mortality for 3 months. Eleven patients (33%) ha d a restrictive filling pattern of deceleration time (DcT) < 120 ms. Plasma ANP and BNP levels were markedly increased in all patients to 189 +/- 145 pg/ml and 865 +/- 559 pg/ml, respectively. Seventeen patients (52%) showed more than 700 pg/ml of plasma levels of BNP. There was a significant correl ation of DcT with the plasma ANP level (r = -0.41, P = 0.017), and a better correlation of DcT with the plasma BNP level(r = -0.50, P = 0.003). The co mbined index of both shorter DcT ((120 ms) and higher plasma BNP levels (> 700 pg/ml) was the best predictor of cardiac mortality by Cox univariate an alysis (chi (2) = 5.87, P = 0.015). Furthermore, the sensitivity and specif icity of this index for the detection of cardiac mortality were 80% and 86% , respectively. In conclusion, the combined analysis of the Doppler transmi tral flow velocity pattern and measurement of the plasma BNP level is notew orthy since it is noninvasive and convenient. Moreover, it is extremely use ful in predicting the prognosis for patients with chronic CHF admitted for episodes of acute decompensation.