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. 2008 Sep 8:6:45.
doi: 10.1186/1476-7120-6-45.

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

Fabian Knebel  1 , Stephan Eddicks, Ingolf Schimke, Michael Bierbaum, Sebastian Schattke, Mark Beling, Vanessa Raab, Gert Baumann, Adrian C Borges
Affiliations

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

Fabian Knebel et al. Cardiovasc Ultrasound. .

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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Figures

Figure 1
Figure 1
Basal segment strain [%] in patients with severely and moderately reduced left ventricular function and patients with preserved systolic function and diastolic dysfunction. Right boxplots: healthy controls. White: lateral, grey: septal strain.
Figure 2
Figure 2
Receiver Operating Characteristic curve to evaluate the diagnostic accuracy of NT-proBNP to separate patients with diastolic and/or systolic dysfunction (n = 95) from healthy controls (n = 42). The area under the curve (AUC) = 0.763 (p < 0.0001), Youden index = 0.44. The optimal cut-off is 97 pg/ml.
Figure 3
Figure 3
NT-proBNP [pg/ml] in patients with normal systolic function (n = 85) according to E/E' ratio.
Figure 4
Figure 4
Longitudinal displacement in patients with normal left ventricular function according to E/E'. White: lateral, grey: septal longitudinal displacement.
See this image and copyright information in PMC

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