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Natriuretic peptide B plasma concentration increases in the first 12 h of pulmonary edema recovery

Published:March 17, 2018DOI:https://doi.org/10.1016/j.ejim.2018.03.007

      Highlights

      • Single BNP value is used for distinguishing cardiac and non-cardiac acute dyspnea.
      • BNP changes during acute cardiogenic pulmonary edema recovery is unknown.
      • In 50 chronic HF patients BNP increased up to 12 h after admission.
      • The quantitative mean of BNP in acute cardiogenic pulmonary edema is questionable.
      • Single BNP determination in acute hemodynamic impairment setting could be not sufficient.

      Abstract

      Background

      According to guidelines, single determination of B-type Natriuretic peptide (BNP) should be used for distinguishing between cardiac and non-cardiac acute dyspnea at the emergency room. BNP measurement is also recommended before hospital discharge in patients hospitalized for heart failure to assess prognosis and to evaluate treatment efficacy.
      In acute cardiogenic pulmonary edema, BNP is measured using a single BNP determination, but the temporal behavior of BNP during pulmonary edema recovery is unknown.

      Methods

      Fifty chronic low ejection fraction (<40%) heart failure patients (age 77 ± 9 years, 17 M-33F) admitted for acute pulmonary edema were studied. Patients were grouped according to 50% dyspnea recovery time into 3 groups: ≤30 min (n = 14), 30 to 60 min (n = 19), and > 60 min (n = 17). BNP was measured at arrival and 4, 8, 12 and 24 h afterwards.

      Results

      At arrival, BNP was elevated in all patients without significant difference among groups. In the entire population, BNP median and interquartile range value were 791 (528–1327) pg/ml, 785(559–1299) pg/ml, 1014(761–1573) pg/ml, 1049(784–1412) pg/ml, 805(497–1271) pg/ml at arrival and 4, 8, 12 and 24 h afterwards, respectively, showing higher values at 8 and 12 h. This peculiar temporal behavior of BNP was shared by all study groups. Patients with the longest edema resolution showed the highest BNP level 8 and 12 h after admission.

      Conclusions

      In acute pulmonary edema, BNP increased up to 12 h after emergency admission regardless of dyspnea recovery time, making BNP quantitative meaning in the acute phase of pulmonary edema uncertain.

      Keywords

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