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The Relation Between Global Longitudinal Strain and Serum Natriuretic Peptide Is More Strict Than That Found Between the Latter and Left Ventricular Ejection Fraction: A Retrospective Study in Chronic Heart Failure.

De Vecchis R, Baldi C, Di Biase G - J Clin Med Res (2015)

Bottom Line: As regards the two determinations, the one echocardiographic and the other laboratory-based, the former should have been done not more than 24 hours before or after the latter.However, the C statistics for GLS were significantly higher than for LVEF (area under the curve (AUC): 0.949 (GLS) vs. 0.730 (LVEF); P = 0.0030).Thus, in both CHF with preserved and reduced LVEF, GLS is more accurate compared with LVEF in predicting increased levels of NT-proBNP.

View Article: PubMed Central - PubMed

Affiliation: Cardiology Unit, Presidio Sanitario Intermedio "Elena d'Aosta", ASL Napoli 1 Centro, Napoli, Italy.

ABSTRACT

Background: In chronic heart failure (CHF), the finding of elevated levels of the N-terminal fragment of the pro B-type natriuretic peptide (NT-proBNP) is a marker of pathological increase in myocardial ventricular wall stress and detrimental rise in ventricular filling pressures. However, the ensemble of data concerning the relationship between longitudinal deformation indices and NT-proBNP is still rather vague and approximate.

Methods: We carried out a retrospective study that involved 118 patients with CHF admitted to our clinic for CHF outpatients. For inclusion in the study, the CHF patients were required to have undergone at least a determination of global longitudinal strain (GLS) by means of speckle tracking echocardiography and to have practiced at least a determination of NT-proBNP. As regards the two determinations, the one echocardiographic and the other laboratory-based, the former should have been done not more than 24 hours before or after the latter.

Results: Correlation between log (NT-proBNP) and GLS was highly significant (r = 0.8386; P < 0.0001). The observed correlation between log (NT-proBNP) and left ventricular ejection fraction (LVEF) was also significant, but explained a smaller magnitude of the variance (r = -0.5465; P < 0.0001). In multiple linear regression analysis, GLS was shown to be the strongest independent predictor of log (NT-proBNP), within a parsimonious model including age, body mass index, estimated glomerular filtration rate, left atrial volume index, and LVEF (β (regression coefficient) = 305, rpartial = 0.7076; P < 0.0001). By using the median value of NT-proBNP (299.5 pg/mL) as a discriminating value for identifying relatively low (i.e., below the median) and relatively high (i.e., above the median) levels of NT-proBNP, GLS was associated with the upper quartiles, whereas LVEF was associated with lower quartiles of NT-proBNP. However, the C statistics for GLS were significantly higher than for LVEF (area under the curve (AUC): 0.949 (GLS) vs. 0.730 (LVEF); P = 0.0030).

Conclusions: In CHF patients, GLS shows a stronger association with NT-proBNP levels with respect to LVEF. Thus, in both CHF with preserved and reduced LVEF, GLS is more accurate compared with LVEF in predicting increased levels of NT-proBNP.

No MeSH data available.


Related in: MedlinePlus

The values of LVEF (%) of each patient are plotted against the respective values of serum NT-proBNP. Each circlet, corresponding to a given value of LVEF, falls in one of the four groups of circlets coincident with the quartiles of NT-proBNP derived from the categorization of the entire range of possible NT-proBNP values in the context of the 50 patients included in the study. The lowest quartile includes the NT-proBNP values ≤ 58 pg/mL, the quartile between the 26th percentile and the median (50th percentile) includes values > 58 and ≤ 299.5 pg/mL, the quartile between 51th and the 75th percentile includes the values > 299.5 and ≤ 1,405 pg/mL, the highest quartile incorporates the values > 1,405 pg/mL up to the highest value found, i.e., 4,123 pg/mL. Please note that the values of LVEF are distributed within the whole range of the possible NT-proBNP values, so it is not possible to identify the existence of a significant inverse linear relationship between LVEF and serum NT-proBNP in the study population (Fig. 4). LVEF: left ventricular ejection fraction; NT-proBNP: N-terminal fragment of the prohormone of the B-type natriuretic peptide.
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Figure 3: The values of LVEF (%) of each patient are plotted against the respective values of serum NT-proBNP. Each circlet, corresponding to a given value of LVEF, falls in one of the four groups of circlets coincident with the quartiles of NT-proBNP derived from the categorization of the entire range of possible NT-proBNP values in the context of the 50 patients included in the study. The lowest quartile includes the NT-proBNP values ≤ 58 pg/mL, the quartile between the 26th percentile and the median (50th percentile) includes values > 58 and ≤ 299.5 pg/mL, the quartile between 51th and the 75th percentile includes the values > 299.5 and ≤ 1,405 pg/mL, the highest quartile incorporates the values > 1,405 pg/mL up to the highest value found, i.e., 4,123 pg/mL. Please note that the values of LVEF are distributed within the whole range of the possible NT-proBNP values, so it is not possible to identify the existence of a significant inverse linear relationship between LVEF and serum NT-proBNP in the study population (Fig. 4). LVEF: left ventricular ejection fraction; NT-proBNP: N-terminal fragment of the prohormone of the B-type natriuretic peptide.

Mentions: The total study population consisted of 118 patients all suffering from CHF, who were cared for in our clinic for heart failure outpatients. Twenty-six patients were excluded from the analysis due to atrial fibrillation (23 patients) and ventricular paced rhythm (three patients). Forty-two patients were excluded due to poor image quality causing three or more myocardial segments to be incorrectly traced by the speckle tracking algorithm. Thus, 50 patients were included in the analyses (median age 69 years (interquartile range 56 - 78 years), 32 (64%) males). Mean LVEF was 52% and mean LV GLS was -15%. The level of NT-proBNP ranged from 35 to 4,123 pg/mL, with a median of 299.5 pg/mL (interquartile range 58 - 1,405 pg/mL). The overall linear relationships between log (NT-proBNP) and GLS and LVEF are shown in Figures 1-4. Correlation between log (NT-proBNP) and GLS was significant (P < 0.0001, r = 0.8386) (Fig. 2). The observed correlation between log (NT-proBNP) and LVEF was also significant, but explained a smaller magnitude of the variance (P < 0.0001, r = -0.5465) (Fig. 4). In CHF patients with reduced ejection fraction (HFREF) (17 patients, 34%) and in those with preserved ejection fraction (HFpEF) (33 patients, 66%) analyzed separately, log (NT-proBNP) exhibited a stronger overall correlation with GLS (HFREF, P < 0.0001, r = 0.8426; HFpEF, P < 0.0001, r = 0.8843) compared with LVEF (HFREF, P = 0.1568, r = -0.3592; HFpEF, P = 0.0502, r = -0.3437). In multiple linear regression analysis, GLS was shown to be as an independent predictor of log (NT-proBNP), within a parsimonious model including age, body mass index, estimated glomerular filtration rate, left atrial volume index, and LVEF (β (regression coefficient) = 305, rpartial = 0.7076; P < 0.0001) (Table 1).


The Relation Between Global Longitudinal Strain and Serum Natriuretic Peptide Is More Strict Than That Found Between the Latter and Left Ventricular Ejection Fraction: A Retrospective Study in Chronic Heart Failure.

De Vecchis R, Baldi C, Di Biase G - J Clin Med Res (2015)

The values of LVEF (%) of each patient are plotted against the respective values of serum NT-proBNP. Each circlet, corresponding to a given value of LVEF, falls in one of the four groups of circlets coincident with the quartiles of NT-proBNP derived from the categorization of the entire range of possible NT-proBNP values in the context of the 50 patients included in the study. The lowest quartile includes the NT-proBNP values ≤ 58 pg/mL, the quartile between the 26th percentile and the median (50th percentile) includes values > 58 and ≤ 299.5 pg/mL, the quartile between 51th and the 75th percentile includes the values > 299.5 and ≤ 1,405 pg/mL, the highest quartile incorporates the values > 1,405 pg/mL up to the highest value found, i.e., 4,123 pg/mL. Please note that the values of LVEF are distributed within the whole range of the possible NT-proBNP values, so it is not possible to identify the existence of a significant inverse linear relationship between LVEF and serum NT-proBNP in the study population (Fig. 4). LVEF: left ventricular ejection fraction; NT-proBNP: N-terminal fragment of the prohormone of the B-type natriuretic peptide.
© Copyright Policy - open access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4625819&req=5

Figure 3: The values of LVEF (%) of each patient are plotted against the respective values of serum NT-proBNP. Each circlet, corresponding to a given value of LVEF, falls in one of the four groups of circlets coincident with the quartiles of NT-proBNP derived from the categorization of the entire range of possible NT-proBNP values in the context of the 50 patients included in the study. The lowest quartile includes the NT-proBNP values ≤ 58 pg/mL, the quartile between the 26th percentile and the median (50th percentile) includes values > 58 and ≤ 299.5 pg/mL, the quartile between 51th and the 75th percentile includes the values > 299.5 and ≤ 1,405 pg/mL, the highest quartile incorporates the values > 1,405 pg/mL up to the highest value found, i.e., 4,123 pg/mL. Please note that the values of LVEF are distributed within the whole range of the possible NT-proBNP values, so it is not possible to identify the existence of a significant inverse linear relationship between LVEF and serum NT-proBNP in the study population (Fig. 4). LVEF: left ventricular ejection fraction; NT-proBNP: N-terminal fragment of the prohormone of the B-type natriuretic peptide.
Mentions: The total study population consisted of 118 patients all suffering from CHF, who were cared for in our clinic for heart failure outpatients. Twenty-six patients were excluded from the analysis due to atrial fibrillation (23 patients) and ventricular paced rhythm (three patients). Forty-two patients were excluded due to poor image quality causing three or more myocardial segments to be incorrectly traced by the speckle tracking algorithm. Thus, 50 patients were included in the analyses (median age 69 years (interquartile range 56 - 78 years), 32 (64%) males). Mean LVEF was 52% and mean LV GLS was -15%. The level of NT-proBNP ranged from 35 to 4,123 pg/mL, with a median of 299.5 pg/mL (interquartile range 58 - 1,405 pg/mL). The overall linear relationships between log (NT-proBNP) and GLS and LVEF are shown in Figures 1-4. Correlation between log (NT-proBNP) and GLS was significant (P < 0.0001, r = 0.8386) (Fig. 2). The observed correlation between log (NT-proBNP) and LVEF was also significant, but explained a smaller magnitude of the variance (P < 0.0001, r = -0.5465) (Fig. 4). In CHF patients with reduced ejection fraction (HFREF) (17 patients, 34%) and in those with preserved ejection fraction (HFpEF) (33 patients, 66%) analyzed separately, log (NT-proBNP) exhibited a stronger overall correlation with GLS (HFREF, P < 0.0001, r = 0.8426; HFpEF, P < 0.0001, r = 0.8843) compared with LVEF (HFREF, P = 0.1568, r = -0.3592; HFpEF, P = 0.0502, r = -0.3437). In multiple linear regression analysis, GLS was shown to be as an independent predictor of log (NT-proBNP), within a parsimonious model including age, body mass index, estimated glomerular filtration rate, left atrial volume index, and LVEF (β (regression coefficient) = 305, rpartial = 0.7076; P < 0.0001) (Table 1).

Bottom Line: As regards the two determinations, the one echocardiographic and the other laboratory-based, the former should have been done not more than 24 hours before or after the latter.However, the C statistics for GLS were significantly higher than for LVEF (area under the curve (AUC): 0.949 (GLS) vs. 0.730 (LVEF); P = 0.0030).Thus, in both CHF with preserved and reduced LVEF, GLS is more accurate compared with LVEF in predicting increased levels of NT-proBNP.

View Article: PubMed Central - PubMed

Affiliation: Cardiology Unit, Presidio Sanitario Intermedio "Elena d'Aosta", ASL Napoli 1 Centro, Napoli, Italy.

ABSTRACT

Background: In chronic heart failure (CHF), the finding of elevated levels of the N-terminal fragment of the pro B-type natriuretic peptide (NT-proBNP) is a marker of pathological increase in myocardial ventricular wall stress and detrimental rise in ventricular filling pressures. However, the ensemble of data concerning the relationship between longitudinal deformation indices and NT-proBNP is still rather vague and approximate.

Methods: We carried out a retrospective study that involved 118 patients with CHF admitted to our clinic for CHF outpatients. For inclusion in the study, the CHF patients were required to have undergone at least a determination of global longitudinal strain (GLS) by means of speckle tracking echocardiography and to have practiced at least a determination of NT-proBNP. As regards the two determinations, the one echocardiographic and the other laboratory-based, the former should have been done not more than 24 hours before or after the latter.

Results: Correlation between log (NT-proBNP) and GLS was highly significant (r = 0.8386; P < 0.0001). The observed correlation between log (NT-proBNP) and left ventricular ejection fraction (LVEF) was also significant, but explained a smaller magnitude of the variance (r = -0.5465; P < 0.0001). In multiple linear regression analysis, GLS was shown to be the strongest independent predictor of log (NT-proBNP), within a parsimonious model including age, body mass index, estimated glomerular filtration rate, left atrial volume index, and LVEF (β (regression coefficient) = 305, rpartial = 0.7076; P < 0.0001). By using the median value of NT-proBNP (299.5 pg/mL) as a discriminating value for identifying relatively low (i.e., below the median) and relatively high (i.e., above the median) levels of NT-proBNP, GLS was associated with the upper quartiles, whereas LVEF was associated with lower quartiles of NT-proBNP. However, the C statistics for GLS were significantly higher than for LVEF (area under the curve (AUC): 0.949 (GLS) vs. 0.730 (LVEF); P = 0.0030).

Conclusions: In CHF patients, GLS shows a stronger association with NT-proBNP levels with respect to LVEF. Thus, in both CHF with preserved and reduced LVEF, GLS is more accurate compared with LVEF in predicting increased levels of NT-proBNP.

No MeSH data available.


Related in: MedlinePlus