Early and Serial Assessment of N-Terminal Pro B-Type Natriuretic Peptide and Inferior Vena Cava Diameter for Mortality Prediction in Acute Decompensated Heart Failure
-
Ahmed Rostom Abdelmoniem
,
Mennatullah Magid Abdel-Maksoud
,
Amr Elsayed Elhadidi
,
Ahmed Abdelrahman Battah
,
Doaa Atef Moubarez
Abstract
Background: Accurate assessment of volume status in cases with acutely decompensated heart failure (ADHF) is crucial for prognostication and management. While brain natriuretic peptide (pro-BNP) and echocardiographic inferior vena cava (IVC) diameter are commonly used surrogate markers, their combined prognostic value has not been thoroughly established.
Methods: This prospective cohort study included 100 adults with ADHF and reduced ejection fraction (EF <40%). Pro-BNP levels and IVC diameter were assessed on admission and after 72 hours. The primary outcome was in-hospital mortality; secondary outcomes included complications and 30-day cardiovascular mortality. Repeated measures ANOVA, ROC analysis, and correlation testing were performed to evaluate predictive value.
Results: In-hospital mortality occurred in 21% of cases. Pro-BNP levels were significantly higher in non-survivors both on admission (median: 11,542 pg/mL vs. 6,350 pg/mL, p<0.001) and after 72 hours (3,695 pg/mL vs. 3,029 pg/mL, p<0.001). Similarly, IVC diameter was significantly greater in the mortality group at both time points (2.85 cm vs. 2.2 cm on admission, p<0.001; 2.15 cm vs. 1.9 cm after 72 hours, p=0.004). ROC analysis revealed strong predictive power for in-hospital mortality with admission Pro-BNP >8,856 pg/mL (AUC=0.89) and IVC diameter >2.55 cm (AUC=0.81). A combined model incorporating both parameters at admission yielded the highest diagnostic accuracy (AUC=0.89; NPV=95.4%).
Conclusion: Pro-BNP and IVC diameter are independent yet complementary predictors of in-hospital mortality in ADHF. Combined early assessment significantly enhances risk stratification and may guide intensive monitoring and therapeutic strategies.
[2] Whalley GA, Doughty RN, Gamble GD, Wright SP, Walsh HJ, Muncaster SA, et al. Pseudonormal mitral filling pattern predicts hospital re-admission in patients with congestive heart failure. J Am Coll Cardiol. 2002;39(11):1787-95.
[3] Wiener RS, Welch HG. Trends in the use of the pulmonary artery catheter in the United States, 1993-2004. Jama. 2007;298(4):423-9.
[4] Maisel AS, McCord J, Nowak RM, Hollander JE, Wu AH, Duc P, et al. Bedside B-Type natriuretic peptide in the emergency diagnosis of heart failure with reduced or preserved ejection fraction. Results from the Breathing Not Properly Multinational Study. J Am Coll Cardiol. 2003;41(11):2010-7.
[5] Kirkpatrick JN, Vannan MA, Narula J, Lang RM. Echocardiography in heart failure: applications, utility, and new horizons. J Am Coll Cardiol. 2007;50(5):381-96.
[6] Pudil R, Tichý M, Praus R, Bláha V, Vojácek J. NT-proBNP and echocardiographic parameters in patients with acute heart failure. Acta Medica (Hradec Kralove). 2007;50(1):51-6.
[7] Redfield MM, Rodeheffer RJ, Jacobsen SJ, Mahoney DW, Bailey KR, Burnett JC, Jr. Plasma brain natriuretic peptide concentration: impact of age and gender. J Am Coll Cardiol. 2002;40(5):976-82.
[8] Jobs A, Vonthein R, König IR, Schäfer J, Nauck M, Haag S, et al. Inferior vena cava ultrasound in acute decompensated heart failure: design rationale of the CAVA-ADHF-DZHK10 trial. ESC Heart Fail. 2020;7(3):973-83.
[9] Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18(12):1440-63.
[10] Price S, Platz E, Cullen L, Tavazzi G, Christ M, Cowie MR, et al. Expert consensus document: Echocardiography and lung ultrasonography for the assessment and management of acute heart failure. Nat Rev Cardiol. 2017;14(7):427-40.
[11] Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation. 2020;141(9):e139-e596.
[12] Arıkan H, Karakurt S. The place of inferior vena cava diameter and proBNP levels in determining the fluid balance of medical intensive care patients. Marmara Medical Journal. 2021;34(1):1-5.
[13] Tsutsui RS, Borowski A, Tang WH, Thomas JD, Popović ZB. Precision of echocardiographic estimates of right atrial pressure in patients with acute decompensated heart failure. J Am Soc Echocardiogr. 2014;27(10):1072-8.e2.
[14] Emmons-Bell S, Johnson C, Roth G. Prevalence, incidence and survival of heart failure: a systematic review. Heart. 2022;108(17):1351-60.
[15] Sud M, Wang X, Austin PC, Lipscombe LL, Newton GE, Tu JV, et al. Presentation blood glucose and death, hospitalization, and future diabetes risk in patients with acute heart failure syndromes. Eur Heart J. 2015;36(15):924-31.
[16] Januzzi JL, van Kimmenade R, Lainchbury J, Bayes-Genis A, Ordonez-Llanos J, Santalo-Bel M, et al. NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure: an international pooled analysis of 1256 patients: the International Collaborative of NT-proBNP Study. Eur Heart J. 2006;27(3):330-7.
[17] Januzzi JL, Jr., Sakhuja R, O'Donoghue M, Baggish AL, Anwaruddin S, Chae CU, et al. Utility of amino-terminal pro-brain natriuretic peptide testing for prediction of 1-year mortality in patients with dyspnea treated in the emergency department. Arch Intern Med. 2006;166(3):315-20.
[18] Bhatia MS, Sharda SC, Attri R, Pannu AK, Dahiya N. Correlation of mortality with Pro-BNP and precipitating factors of acute heart failure in patients presenting to a medical emergency of tertiary care hospital: an observational study from north India. Eur Rev Med Pharmacol Sci. 2022;26(18):6459-68.
[19] Khanam SS, Son JW, Lee JW, Youn YJ, Yoon J, Lee SH, et al. Prognostic value of short-term follow-up BNP in hospitalized patients with heart failure. BMC Cardiovasc Disord. 2017;17(1):215.
[20] Lee HF, Hsu LA, Chang CJ, Chan YH, Wang CL, Ho WJ, et al. Prognostic significance of dilated inferior vena cava in advanced decompensated heart failure. Int J Cardiovasc Imaging. 2014;30(7):1289-95.
[21] Cubo-Romano P, Torres-Macho J, Soni NJ, Reyes LF, Rodríguez-Almodóvar A, Fernández-Alonso JM, et al. Admission inferior vena cava measurements are associated with mortality after hospitalization for acute decompensated heart failure. J Hosp Med. 2016;11(11):778-84.
[22] Haag S, Jobs A, Stiermaier T, Fichera CF, Paitazoglou C, Eitel I, et al. Lack of correlation between different congestion markers in acute decompensated heart failure. Clin Res Cardiol. 2023;112(1):75-86.
[23] Josa-Laorden C, Giménez-López I, Rubio-Gracia J, Ruiz-Laiglesia F, Garcés-Horna V, Pérez-Calvo JI. Valor pronóstico de la medición del diámetro y colapso inspiratorio de la vena cava inferior en la insuficiencia cardiaca aguda. Revista Clínica Española. 2016;216(4):183-90.
[24] MA L. Predictive value of NT-proBNP level and IVC-CI on volume load and prognosis in patients with acute heart failure. Journal of Medical Postgraduates. 2020:289-95.
[25] Hebl V, Zakharova MY, Canoniero M, Duprez D, Garcia S. Correlation of natriuretic peptides and inferior vena cava size in patients with congestive heart failure. Vasc Health Risk Manag. 2012;8:213-8.
| Files | ||
| Issue | Article in Press |
|
| Section | Research Article(s) | |
| Keywords | ||
| Heart Failure Pro-BNP Inferior Vena Cava Diameter Echocardiography In-Hospital Mortality | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
