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Preclinical systolic and diastolic dysfunction assessed by tissue Doppler imaging is associated with elevated plasma
Rasmus Mogelvang1, Jens P Goetze, Sune A Pedersen
1Copenhagen City Heart Study, Epidemiological Research Unit, Bispebjerg Hospital, Copenhagen, Denmark. Rasmus.Mogelvang@get2net.dk
Insights
Tissue Doppler imaging (TDI) detects early cardiac dysfunction, even before conventional echocardiography shows abnormalities. This preclinical dysfunction is linked to elevated pro-brain natriuretic peptide levels, aiding heart failure risk assessment.
Area of Science:
- Cardiology
- Medical Imaging
- Biomarkers
Background:
- Heart failure presents a significant public health challenge.
- Early detection of cardiac dysfunction is crucial for improving prognosis.
- Conventional echocardiography has limitations in identifying early dysfunction.
Purpose of the Study:
- To evaluate the utility of Tissue Doppler Imaging (TDI) for detecting preclinical cardiac dysfunction.
- To assess the association between TDI-derived cardiac function parameters and plasma pro-brain natriuretic peptide (proBNP) levels.
Main Methods:
- A community-based study involving 1012 participants.
- Cardiac function assessed using conventional echocardiography and TDI.
- Plasma proBNP levels were measured.
- TDI parameters included peak systolic (s') and early/late diastolic (e', a') velocities, and an eas-index.
Main Results:
- Individuals with elevated proBNP showed significantly impaired systolic and diastolic function by TDI (lower s', a'; higher e'/a' and eas-index).
- These findings persisted after multivariable adjustment for various clinical factors.
- TDI provided additional predictive information beyond conventional echocardiography for elevated proBNP.
Conclusions:
- Preclinical systolic and diastolic dysfunction, identified by TDI, correlates with elevated plasma proBNP.
- TDI can detect cardiac dysfunction earlier than conventional echocardiography, even when other measures are normal.
Background:
Heart failure is a major public health problem. To improve its grave prognosis, early identification of cardiac dysfunction is mandatory. Conventional echocardiography is not suitable for this. Tissue Doppler imaging (TDI), however, could be so.
Methods And Results:
Within a large community-based population-study (n = 1012), cardiac function was evaluated by conventional echocardiography (left ventricular hypertrophy, dilatation, systolic, and severe diastolic dysfunction), TDI, and plasma proBNP. Averages of peak systolic (s'), early diastolic (e'), and late diastolic (a') velocities from 6 mitral annular sites were used. TDI was furthermore quantified by a combined index (eas-index) of diastolic and systolic performance: e'/(a' x s'). Compared with controls, persons with elevated plasma proBNP concentrations (n = 100) displayed lower systolic and diastolic performance by TDI, in terms of lower s' (P = 0.017) and a' (P < .001), and higher e'/a' (P = .002) and eas-index (P < .001). This pattern remained significant after multivariable adjustment for age, sex, body mass index, heart rate, estimated glomerular filtration rate, hypertension, diabetes, ischemic heart disease, and conventional echocardiography. Furthermore, TDI provided incremental information over conventional echocardiography in predicting elevated plasma proBNP concentrations.
Conclusions:
Preclinical systolic and diastolic dysfunction by TDI is associated with elevated plasma proBNP levels, even when conventional echocardiography is normal.
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