Vol 13, No 7 (2006): Folia Cardiologica
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Published online: 2006-09-15

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NT-proBNP level in the diagnosis of isolated left ventricular diastolic dysfunction in patients with documented coronary artery disease

Krystian Wita, Artur Filipecki, Wojciech Wróbel, Jolanta Krauze, Agnieszka Drzewiecka-Gerber, Anna Rybicka-Musialik, Mariola Nowak, Zbigniew Tabor, Michał Lelek, Wojciech Kwaśniewski, Maria Trusz-Gluza
Folia Cardiol 2006;13(7):620-625.

Abstract

Background: The diagnostic value of NT-proBNP for left ventricular (LV) systolic dysfunction is well established. However, its role for diastolic dysfunction (DD) diagnosis in patients with preserved systolic function has not been clearly defined.
Methods: A total of 83 patients with documented coronary arterial disease following anterior myocardial infarction and with a left ventricular ejection fraction (LVEF) > 45% were enrolled. According to echocardiographic mitral inflow and right upper pulmonary vein flow, DD was excluded in 32 patients (group A). The patients with DD were divided into three subgroups: B1 - 38 patients with impaired relaxation, B2 - 8 patients with pseudonormalisation and B3 - 7 patients with restrictive inflow. In all patients E-wave propagation (Vp) and NT-proBNP were determined.
Results: Mean LVEF was 56.2 ± 9% and did not differ between the subgroups. NT-proBNP levels were 107 ± 101 pg/ml in group A, 299 ± 281 pg/ml in B1, 734 ± 586 pg/ml in B2 (p < 0.05 vs. A) and 2322 ± 886 pg/ml in B3 (p < 0.01 vs. A and p < 0.01 vs. B2). Propagation Vp was 69 ± 21 cm/s, 56 ± 20 cm/s, 53 ± 17 cm/s (p < 0.05 vs. A) and 44 ± 11 cm/s (p < 0.01 vs. A) respectively. A positive correlation was found for DD degree with NT-proBNP level (r = 0.66; p < 0.001) and negative with Vp (r = –0.41; p < 0.001). ROC curves were constructed to determine the NT-proBNP level cut-off point for DD (> 131 pg/ml, area under the curve: 0.63) and advanced restrictive DD (> 1670 pg/ml, area under the curve: 0.83) diagnosis. Sensitivity, specificity, accuracy and positive and negative predictive values were 71%, 50%, 63%, 69%, 52% and 57%, 99%, 95%, 80%, 96% respectively.
Conclusions: In patients with coronary artery disease and preserved LV systolic function a single NT-proBNP measurement helps to identify those with isolated DD, especially those with advanced restriction.

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