| 정일형¹, 유병수¹ , 왕희성¹ ,정현숙¹ , 김장영¹ , 이승환¹ , 황성오² , 윤정한¹ , 최경훈¹ |
Purpose: The change of BNP level depending on a clinical situation was varied. So we evaluated the BNP reduction depending on the volume status in acute exacerbation of systolic heart failure (SHF). Methods: Between Oct 2002 and June 2004, 120 patients with acute exacerbation (< 1 month) of SHF were included. We defined the volume status as follows; Clinical congestion: in patients with generalized edema or rales on lung sound, Radiological congestion: in patients with interstitial or alveolar edema by radiologist decision. And, we divided the patients into 3 groups as follows. Group I: patients with clinical & radiological congestion (clinical wet & radiological wet status) Group II: only radiological congestion (clinical dry & radiological wet) Group III: patients without clinical & radiological congestion (clinical dry & radiological dry). The blood BNP (Triage, Biosite) level, and clinical parameters were analyzed. Bad prognostic parameter was defined as readmission or death. Results: 1.Mean age was 68.0 and male was 50.0%. Most frequent etiology was valvular heart disease (n=34, 28.3%) and most common precipitating factor was myocardial ischemia (n=54, 45.0%). NYHA class was 3.2 2.Group I was 61.5% (n=64), group II was 24% (n=25) and group III was 14.5% (n=15). There was no patient with clinical wet & radiological dry status in this study. Among 3 groups, there were no significant differences in clinical parameters except EF(p=0.012). Baseline BNP level was higher in patients with group I, II than group III (I:1540±1202, II:1482±1281, III:666±827pg/mL, p=0.036) and also early BNP reduction ratio was higher in group I, II than group III (I:69±27, II:67±32, III:1.3±144%, p=0.007). 3.Readmission and death were 13.3% (n=16). The relationship between early BNP reduction ratio and prognosis was significant (p=0.005). Conclusions: The change of BNP level depending on the degree of congestive status was varied and patients with radiological wet status showed higher initial BNP level and early BNP reduction ratio than patients with dry status. And, we think that early BNP reduction ratio is predictor of bad prognosis in SHF patients.
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