A rapid test for B-type natriuretic peptide correlates with falling wedge pressures in patients treated for decompensated heart failure: A pilot study

Objectives: To determine if changes in B-type natriuretic peptide (BNP) lev els can accurately reflect acute changes in pulmonary capillary wedge press ure during treatment of decompensated heart failure. Background: Tailored therapy of decompensated congestive heart failure with hemodynamic monitoring is controversial. Other than the expense and compli cations of Swan-Ganz catheters, its use in titration of drug therapy has no conclusive end point. Because BNP reflects both elevated left ventricular pressure and neurohormonal modulation and has a short half-life, we hypothe sized that levels of BNP would decline in association with falling wedge pr essures. Final BNP levels would perhaps signify a new set point of neuromod ulation. Methods and Results: Twenty patients with decompensated New York Heart Asso ciation (NYHA) class: III-IV congestive heart failure (CHF) undergoing tail ored therapy were studied. BNP levels were drawn every 2 to 4 hours for the first 24 hours (active treatment phase) and then every 4 hours for the nex t 24 to 48 hours (stabilization period). Hemodynamic data was recorded simu ltaneously. In 15 patients whose wedge pressure responded to treatment in t he first 21 hours. there was a significant drop in BNP levels (55%) versus nonresponders (8%). There was a significant correlation between percent cha nge in wedge pressure from baseline per hour and the percent change of BNP from baseline per hour (r = 0.79, P < .05). When the wedge pressure was kep t at a stable, low level during the stabilization phase. BNP levels continu ed to frill another 37% (937 <plus/minus> 140 pg/mL at 24 hours to 605 +/- 128 pg/mL). Patients who died (n = 1) had higher final BNP levels (1,078 +/ - 123 pg/mL v 701 +/- 107 pg/mL). Conclusions: The data suggest that rapid testing of BNP may be an effective way to improve the in-hospital management of patients admitted with decomp ensated CHF. Although BNP levels will not obviate the need for invasive hem odynamic monitoring, it may be a useful adjunct in tailoring therapy to the se patients.