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Plasma N-terminal pro-brain natriuretic peptide levels identifying left ventricular diastolic dysfunction in patients
Hiroo Sonoda1, Nobuyuki Ohte, Toshihiko Goto
1Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Insights
N-terminal pro-brain natriuretic peptide (NT-proBNP) can help diagnose diastolic dysfunction. Levels below 56.5 pg/ml indicate preserved function, while levels above 244.5 pg/ml suggest impaired relaxation in coronary artery disease patients.
Area of Science:
- Cardiology
- Biomarker Research
Background:
- Diagnosing left ventricular (LV) diastolic dysfunction through blood tests is clinically valuable.
- Coronary artery disease (CAD) patients often present with complex cardiac conditions requiring precise diagnostic tools.
Purpose of the Study:
- To evaluate the efficacy of N-terminal pro-brain natriuretic peptide (NT-proBNP) as a blood test for diagnosing LV diastolic dysfunction.
- To correlate NT-proBNP levels with specific measures of LV relaxation and elastic recoil in patients with CAD.
Main Methods:
- Cardiac catheterization was performed on 98 patients with preserved LV ejection fraction (≥50%) to assess coronary artery disease.
- Left ventricular pressure (LVP) was measured to compute the time constant of LV relaxation (τ) and inertia force (IF) as a surrogate for LV elastic recoil.
- Patients were categorized based on impaired (τ ≥48 ms) versus preserved (τ <48 ms) LV relaxation and the presence (IF ≥0.5 mmHg) or absence (IF <0.5 mmHg) of IF.
Main Results:
- NT-proBNP ≥56.5 pg/ml demonstrated 100% sensitivity and 100% negative predictive value for identifying impaired LV relaxation.
- NT-proBNP ≥244.5 pg/ml showed 62.5% sensitivity and 93.9% specificity for detecting a lack of IF, indicating impaired LV elastic recoil.
- A threshold of NT-proBNP <56.5 pg/ml effectively identified patients with preserved LV systolic and diastolic function.
Conclusions:
- NT-proBNP levels below 56.5 pg/ml can reliably identify patients with preserved LV systolic and diastolic function in the context of CAD.
- NT-proBNP levels ≥244.5 pg/ml are valuable for specifically detecting impaired LV elastic recoil (lack of IF), suggesting potential for diagnosing isolated diastolic dysfunction.
Background:
Diagnosis of left ventricular (LV) diastolic dysfunction by blood testing is expedient in the clinical setting.
Methods And Results:
In 98 patients with LV ejection fraction ≥50% who underwent cardiac catheterization for evaluation of coronary artery disease, LV pressure (LVP) was measured using a catheter-tipped micromanometer. A time constant, τ, of LV relaxation was computed from LVP decay; the inertia force (IF) of late systolic aortic flow, a surrogate index of LV elastic recoil, was also computed from the LVP-dP/dt relation (phase loop). Patients were classified into 2 groups: those with impaired LV relaxation (τ ≥48 ms) and those with preserved LV relaxation (τ <48 ms). Patients were also classified into another 2 groups: those with IF (≥0.5 mmHg) and those without (<0.5 mmHg). Plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) ≥56.5 pg/ml had a sensitivity of 100%, specificity of 52.5%, and negative predictive value of 100% for identifying impaired LV relaxation. NT-proBNP ≥244.5 pg/ml had a sensitivity of 62.5% and specificity of 93.9% for detecting lack of IF.
Conclusions:
NT-proBNP level <56.5 pg/ml could be used as a value to sensitively identify patients with preserved LV systolic and diastolic function among those with coronary artery disease. NT-proBNP level ≥244.5 pg/ml is able to specifically detect a lack of IF and has potential for specifically diagnosing LV isolated diastolic dysfunction.
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