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Myocardial tissue Doppler echocardiography and N-terminal B-type natriuretic peptide (NT-proBNP) in diastolic and systolic heart failure.

Knebel F, Eddicks S, Schimke I, Bierbaum M, Schattke S, Beling M, Raab V, Baumann G, Borges AC - Cardiovasc Ultrasound (2008)

Bottom Line: In diastolic heart failure, basal septal strain was reduced (-24.8 +/- 8.1% vs. controls. -18.5 +/- 5.3%, p < 0.0001).In all patients with preserved systolic function, septal basal longitudinal displacement was impaired in patients with increased left-ventricular filling pressures (E/E' < 8: 13.5 mm +/- 3.3 mm vs.E/E' > 15: 402.0 pg/ml, IQR: 1337.2 pg/ml; p = 0.0007).

View Article: PubMed Central - HTML - PubMed

Affiliation: Universitätsmedizin Berlin, Medical Clinic for Cardiology and Angiology, Charité Campus Mitte, Charitéplatz 1, Berlin, Germany. fabian.knebel@charite.de

ABSTRACT

Background: The aim of this prospective study was to assess the diagnostic value of NT-proBNP and the concordance with Tissue Doppler Echocardiography (including strain and longitudinal displacement) in diastolic and systolic heart failure.

Methods and results: 137 consecutive clinically stable patients were included (42 healthy controls, 43 with diastolic heart failure, 52 with systolic heart failure). In diastolic heart failure, basal septal strain was reduced (-24.8 +/- 8.1% vs. controls. -18.5 +/- 5.3%, p < 0.0001). In all patients with preserved systolic function, septal basal longitudinal displacement was impaired in patients with increased left-ventricular filling pressures (E/E' < 8: 13.5 mm +/- 3.3 mm vs. E/E' > 15: 8.5 mm +/- 2.3 mm, p = 0.001) parallel to NT-proBNP elevation (E/E' < 8: 45.8 pg/ml, IQR: 172.5 pg/ml vs. E/E' > 15: 402.0 pg/ml, IQR: 1337.2 pg/ml; p = 0.0007). In ROC analysis, NT-proBNP could detect patients with reduced left ventricular systolic function (LVEF >or= 55%) with a good diagnostic accuracy. However, the diagnostic accuracy of NT-proBNP to detect diastolic dysfunction was lower.

Conclusion: Subtle changes of longitudinal myocardial function begin in diastolic heart failure and are further increased in systolic heart failure. In patients with preserved LV function, a complex approach with the integration of multiple parameters including Tissue Doppler echocardiography and NT-proBNP is necessary to classify patients.

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NT-proBNP [pg/ml] in patients with normal systolic function (n = 85) according to E/E' ratio.
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Figure 3: NT-proBNP [pg/ml] in patients with normal systolic function (n = 85) according to E/E' ratio.

Mentions: Dividing the patients with preserved systolic LV function (groups 1 and 2) by E/E' (cut-point = 8) showed that there were significant differences in NT-proBNP levels (E/E' < 8: median NT-proBNP: 45.8, IQR: 172.6 pg/ml, E/E' > 8: 114.6 (261.7), p = 0.01). Classifying these patients by E/E' < 8, E/E' 8–15 and E/E' > 15 according to [14,33] revealed that those with increased filling pressures (E/E' > 15) had significantly elevated NT-proBNP and reduced longitudinal displacement values compared to patients with E/E' < 8. Strain, in contrast, was not significantly impaired. The patients with an E/E' 8–15 did not differ significantly in NT-proBNP levels compared to patients with E/E' < 8 or E/E' > 15 (figures 3 and 4).


Myocardial tissue Doppler echocardiography and N-terminal B-type natriuretic peptide (NT-proBNP) in diastolic and systolic heart failure.

Knebel F, Eddicks S, Schimke I, Bierbaum M, Schattke S, Beling M, Raab V, Baumann G, Borges AC - Cardiovasc Ultrasound (2008)

NT-proBNP [pg/ml] in patients with normal systolic function (n = 85) according to E/E' ratio.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2542999&req=5

Figure 3: NT-proBNP [pg/ml] in patients with normal systolic function (n = 85) according to E/E' ratio.
Mentions: Dividing the patients with preserved systolic LV function (groups 1 and 2) by E/E' (cut-point = 8) showed that there were significant differences in NT-proBNP levels (E/E' < 8: median NT-proBNP: 45.8, IQR: 172.6 pg/ml, E/E' > 8: 114.6 (261.7), p = 0.01). Classifying these patients by E/E' < 8, E/E' 8–15 and E/E' > 15 according to [14,33] revealed that those with increased filling pressures (E/E' > 15) had significantly elevated NT-proBNP and reduced longitudinal displacement values compared to patients with E/E' < 8. Strain, in contrast, was not significantly impaired. The patients with an E/E' 8–15 did not differ significantly in NT-proBNP levels compared to patients with E/E' < 8 or E/E' > 15 (figures 3 and 4).

Bottom Line: In diastolic heart failure, basal septal strain was reduced (-24.8 +/- 8.1% vs. controls. -18.5 +/- 5.3%, p < 0.0001).In all patients with preserved systolic function, septal basal longitudinal displacement was impaired in patients with increased left-ventricular filling pressures (E/E' < 8: 13.5 mm +/- 3.3 mm vs.E/E' > 15: 402.0 pg/ml, IQR: 1337.2 pg/ml; p = 0.0007).

View Article: PubMed Central - HTML - PubMed

Affiliation: Universitätsmedizin Berlin, Medical Clinic for Cardiology and Angiology, Charité Campus Mitte, Charitéplatz 1, Berlin, Germany. fabian.knebel@charite.de

ABSTRACT

Background: The aim of this prospective study was to assess the diagnostic value of NT-proBNP and the concordance with Tissue Doppler Echocardiography (including strain and longitudinal displacement) in diastolic and systolic heart failure.

Methods and results: 137 consecutive clinically stable patients were included (42 healthy controls, 43 with diastolic heart failure, 52 with systolic heart failure). In diastolic heart failure, basal septal strain was reduced (-24.8 +/- 8.1% vs. controls. -18.5 +/- 5.3%, p < 0.0001). In all patients with preserved systolic function, septal basal longitudinal displacement was impaired in patients with increased left-ventricular filling pressures (E/E' < 8: 13.5 mm +/- 3.3 mm vs. E/E' > 15: 8.5 mm +/- 2.3 mm, p = 0.001) parallel to NT-proBNP elevation (E/E' < 8: 45.8 pg/ml, IQR: 172.5 pg/ml vs. E/E' > 15: 402.0 pg/ml, IQR: 1337.2 pg/ml; p = 0.0007). In ROC analysis, NT-proBNP could detect patients with reduced left ventricular systolic function (LVEF >or= 55%) with a good diagnostic accuracy. However, the diagnostic accuracy of NT-proBNP to detect diastolic dysfunction was lower.

Conclusion: Subtle changes of longitudinal myocardial function begin in diastolic heart failure and are further increased in systolic heart failure. In patients with preserved LV function, a complex approach with the integration of multiple parameters including Tissue Doppler echocardiography and NT-proBNP is necessary to classify patients.

Show MeSH
Related in: MedlinePlus