Corelaţia dintre parametrii ecocardiografici convenţionali şi nivelul seric al NTproBNP la…

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Article Title:	Corelaţia dintre parametrii ecocardiografici convenţionali şi nivelul seric al NTproBNP la pacienţii cu disfuncţie ventriculară stângă
Authors:	S. Miclăuş1, C. Mornoş2, D. Maximov2, A. Lupu2, D. Popa2, M. Puşchiţă1
Affiliation:	1 Spitalul Clinic Judeţean de Urgență Arad, România 2 Institutul de Boli Cardiovasculare Timişoara, România
Abstract:	CORRELATIONS BETWEEN CONVENTIONAL ECOCARDIOGRAPHIC PARAMETERS AND SERUM LEVEL OF NTPROBNP IN PATIENTS WITH LEFT VENTRICULAR DYSFUNCTION. Conventional echocardiography is rutinely used for the non-invasive assessment of the patients with left ventricular (LV) disfunction. A combined myocardial performance index (isovolumic contraction time plus isovolumic relaxation time divided by ejection time, ‘Tei-Index’) has been applied in the echocardiographic evaluation of patients with heart failure (HF). N-terminal pro brain natriuretic peptide (NTproBNP) is released from the left ventricular (LV) in response to myocite stretch and is a powerful prognostic marker for HF. Aim: To assess the correlation between Tei index and NTproBNP level in patients withLV disfunction in sinusal rhythm. Methods: We screened 145 consecutive patients with LV dysfunction in sinusal rhythm referred for LV cathetherism. Patients with inadequate echocardiographic image, paced rhythm, mitral stenosis, significant primary or organic mitral regurgitation, mitral prosthesis, severe mitral annular calcification and acute coronary syndrome, coronary artery by-pass within 72 hours or renal failure were excluded. The remaining 113 patients (78 with HF with reduced ejection fraction – HFREF, 12 with HF with normal EF -HFNEF, 23 with isolated diastolic dysfunction) formed our study group. Echocardiography was performed simultaneously with NTproBNP measurement. Tei index was calculated. Results: Simple regression analysis demonstrated a statistically significant linear correlation between NTproBNP and Tei index (r=0.71, p<0,001). NTproBNP had weaker relationship with pulmonary artery systolic pressure, indexed left atrial (LA) volume, LA volume, LV ejection fraction, early diastolic transmitral velocity (E), mitral E deceleration time and no relationship with LA diameter, LV end-diastolic diameter. The area under the ROC curve for prediction of NTproBNP levels >900 pg/ml was maxinal (0.84) for Tei index. The optimal Tei index cut-off for prediction of NTproBNP levels >900 pg/ml was 0.47 (sensitivity=78%, specificity=74%). Among analyzed parameters, Tei index was best correlated with NTproBNP levels in patients with HFNEF (r=0.75, p=0.005), in those with HFREF (r=0.66, p<0.001) and with isolated diastolic dysfunction (r=0.60, p=0.007). Conclusions: Tei index strongly correlates with NTproBNP in patients with LV disfunction in sinus rhythm, and can be a simple and accurate predictor of the serum NTproBNP level.
Keywords:	conventional echocardiography, Tei index, NTproBNP, left ventricular dysfunction
References:	1. Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006;355(3):251-9. 2. Abhayaratna WP, Marwick TH, Smith WT, Becker NG. Characteristics of left ventricular diastolic dysfunction in the community: an echocardiographic survey. Heart. 2006 ;92(9):1259-64. 3. Paulus WJ, Tschöpe C, Sanderson JE, et al. How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J. 2007;28 (20):2539-50. 4. Tei C, Ling LH, Hodge DO et al. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function: a study in normals and dilated cardiomyopathy. J Cardiol 1995; 26: 357–366 5. Harjai KJ, Scott L, Vivekananthan K, Nunez E, Edupuganti R . The Tei index: A new prognostic index for patients with symptomatic heart failure. Journal of the American Society of Echocardiography 2002; 15 (9): 864-868 6. Tiong LK; Houman A ; D Girish. Increased left atrial volume index is an independent predictor of raised serum natriuretic peptide in patients with suspected heart failure but normal left ventricular ejection fraction: Implication for diagnosis of diastolic heart failure.Eur. j. heart fail. 2006;8 :38-45 7. Iwanaga Y, Nishi I, Furuichi S et al . B-type natriuretic peptide strongly reflects diastolic wall stress in patients with chronic heart failure: comparison between systolic and diastolic heart failure. J Am Coll Cardiol 2006; 47:742–748 8. Quiñones MA, Otto C M, Stoddard M. Recommendations for Quantification Of Doppler Echocardiography: A Report From the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography; J Am Soc Echocardiogr 2002;15:167-184 9. Lang RM, Bierig M, Devereux RB et al. Recommendations for chamber quantification. Eur J Echocardiography 2006; 7 (2):79-108 10. Karl J, Borgya A, Galluser A, Huber E, Krueger K, Rollinger W, et al. Development of a novel, N-Terminal-proBNP (NT-proBNP) assay with a low detection limit. Scand J Clin Lab Invest 1999;59:177-181 11. Krauser D, Lloyd-Jones D, Chae C et al. Effect of body mass index on natriuretic peptide levels in patients with acute congestive heart failure : a proBNP Investigation of Dyspneea in the Emergency Departament (PRIDE) substudy. Am Heart J 2005;149 (4):744-750 12. Yu CM, Lin H, Yang H, Kong SL, Zhang Q, Lee SW. Progression of systolic abnormalities in patients with “isolated” diastolic heart failure and diastolic dysfunction. Circulation. 2002;105(10):1195-201. 13. Tretjak M, Verovnik F, Benko D, Kozel M. Tissue Doppler velocities of mitral annulus and NT-proBNP in patients with heart failure. Eur J Heart Fail 2005;7 (4): 520– 524 14. Elnoamany MF, Abdelhameed AK. Mitral annular motion as a surrogate for left ventricular function: Correlation with brain natriuretic peptide levels. Eur J Echocardiography 2006;7 (3):187-198 15. Ceyhan C, Unal S, Yenisey EC et al. The role of N terminal pro-brain natriuretic peptide in the evaluation of left ventricular diastolic dysfunction: correlation with echocardiographic indexes in hypertensive patients. Int J Cardiovasc Imaging 2007; DOI 10.1007/s10554-007-9256-2 16. Barclay JL, Kruszewski K, Croal BL. Relation of left atrial volume to B-type natriuretic peptide levels in patients with stable chronic heart failure. Am J Cardiol. 2006;98(1):98-101 17. Burke M, Cotts W. Interpretation of B-type natriuretic peptide in cardiac disease and other comorbid conditions. Heart Fail Rev 2007;12 (1) : 23-36 18. Felker GM, Petersen JW, Mark DB. Natriuretic peptides in the diagnosis and management of heart failure. CMAJ 2006;175 (6): 611-617
*Correspondence:	Ş. Miclauș,Spitalul Clinic Judeţean de Urgență Arad, România, Email: medicina@uvvg.ro