Abstract:
The research presented within this thesis aims to add to the current knowledge regarding
contemporary heart failure (HF) management.
Chapter 2 describes a study collating twenty years of HF admissions and mortality data from
New Zealand (1988-2008). This study describes changes in HF epidemiology to provide
context for further research focusing on indivudual patient aspects of HF management in the
current era.
Chapter 3 comprises a literature review examining the roles of B-type natriuretic peptide
(BNP, BNP-32 and NT-proBNP) and echocardiography in contemporary HF management.
BNP and echocardiography have important diagnostic and prognostic utility in HF
management and provide non-invasive assessment of left ventricular filling pressure. This
review provides background for the following two chapters.
Chapter 4 describes a study that evaluates the relationship between BNP-32 and
echocardiographic measures of diastolic function (E/Ea) in patients admitted to hospital with
acute decompensated HF.
Chapter 5 describes a study that evaluates the relationship between NT-proBNP and E/Ea in
HF patients during NT-proBNP guided treatment titration.
These chapters add to current knowledge regarding the utility of E/Ea in patients with HF.
Chapters 6 and 7 focus on co-morbidity associated with HF. It has been uncertain from
previously published data whether the presence of atrial fibrillation (AF) in patients with HF
is associated with an adverse prognosis.
Chapter 6 comprises a literature-based meta-analysis of the prognostic effect of AF in HF
compared to those with sinus rhythm. This study combines the results of 20 studies (32,946
patients, 10,819 deaths) and confirms that AF is associated with an adverse prognosis in HF.
Chapter 7 describes a study that evaluates trans-myocardial metabolism of aldosterone,
angiotensin II, BNP-32, and a marker of collagen synthesis in patients with ischaemic heart
disease or severe aortic stenosis who have normal left ventricular ejection fraction. This
study confirms myocardial release of aldosterone despite normal circulating aldosterone levels, strengthening the rationale for evaluation of aldosterone receptor antagonists in
clinical situations not characterised by increased circulating aldosterone.
This research has added to current understanding of HF and HF therapy, particularly
focused on measures that may help to improve individual patient outcomes.