• echocardiography
• heart failure
• natriuretic peptides

Background. The concept of echo and natriuretic peptide (NP) guided therapy is appealing since currently there is no objective guide to optimal dosing of therapy and loop diuretics in particular in patients with chronic heart failure (CHF).

Aim. To assess whether echo and NP guided therapy may be useful for the management of patients with CHF due to left ventricular systolic dysfunction.

Materials and methods. We retrospectively analyzed the multicentric individual data of 414 patients with CHF with reduced ejection fraction; during ambulatory follow-up, the therapy (including loop diuretics) was titrated according to the presence of echocardiographic signs of elevated left ventricular filling pressures and NP serum levels. Mortality rate, changes in renal function, NP levels, cardiac function and medication doses were analyzed.

Results. The median follow-up duration was 1030 days. The mortality rate was 3,7% per year. During the observation period, the dose of loop diuretics increased by 20%. An increase of ≥ 0.3 mg/dL in serum creatinine was reported in 15% of the patients. Newly diagnosed renal dysfunction (eGFR <60 ml/min/1.73m2) occurred in 10% of patients. There was a significant decrease in NP levels and an improvement in LV filling pressures and systolic function. Regarding other therapies, significantly more patients were using beta blockers at follow up and the doses were increased. Non significant changes in the percentage of patients treated and in the medication dose was noted for Angiotensin Converting Enzyme Inhibitors/ Angiotensin Type 1 Receptor Blockers (ACEi/ARB) and for Mineralocorticoid Receptor Antagonists (MRA).

Conclusion. Our study suggests that the outcome of patients with CHF might be improved by the integrative use of clinical examination, biochemical and echocardiographic parameters. These effects are likely to be mediated by an appropriate use of loop diuretics and kidney function preservation.