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Adv Exp Med Biol. 2018;1067:145-159. doi: 10.1007/5584_2017_137.

Optimizing Management of Heart Failure by Using Echo and Natriuretic Peptides in the Outpatient Unit.

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Cardiovascular and Thoracic Department, University of Pisa, Pisa, Italy.
Unità Operativa Malattie Cardiovascolari 1, Dipartimento Cardio, Toracico e Vascolare, Azienda Ospedaliera-Universitaria Pisana, Pisa, Italy.
Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden.
Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo.
Cardiovascular and Thoracic Department, University of Pisa, Pisa, Italy.
Department of Internal Medicine, Livorno Hospital, Livorno, Italy.
Department of Internal Medicine and Medical Specialities, University of Genoa, Genoa, Italy.


Chronic heart failure (HF) is an important public health problem and is associated with high morbidity, high mortality, and considerable healthcare costs. More than 90% of hospitalizations due to worsening HF result from elevations of left ventricular (LV) filling pressures and fluid overload, which are often accompanied by the increased synthesis and secretion of natriuretic peptides (NPs). Furthermore, persistently abnormal LV filling pressures and a rise in NP circulating levels are well known indicators of poor prognosis. Frequent office visits with the resulting evaluation and management are most often needed. The growing pressure from hospital readmissions in HF patients is shifting the focus of interest from traditionally symptom-guided care to a more specific patient-centered follow-up care based on clinical findings, BNP and echo. Recent studies supported the value of serial NP measurements and Doppler echocardiographic biomarkers of elevated LV filling pressures as tools to scrutinize patients with impending clinically overt HF. Therefore, combination of echo and pulsed-wave blood-flow and tissue Doppler with NPs appears valuable in guiding ambulatory HF management, since they are potentially useful to distinguish stable patients from those at high risk of decompensation.


Cardiac output; Diastolic dysfunction; Echocardiography; Ejection fraction; Heart failure; Hemodynamic profiles; Natriuretic peptides; Prognosis; Pulmonary capillary wedge pressure

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