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Diastolic stress echocardiography and biomarkers in patients with preserved left ventricle ejection fraction and heart failure symptoms

Andrzej Kubicius1, Mariusz Bałys2, Quirino Ciampi3, Eugenio Picano4, Zbigniew Gąsior2, Maciej Haberka2
DOI: 10.33963/KP.a2022.0070
·
Pubmed: 35285508
Affiliations
  1. Department of Cardiology in Cieszyn, Upper Silesia Medical Center, Medical University of Silesia, Katowice, Poland
  2. Department of Cardiology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
  3. Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
  4. CNR Institute of Clinical Physiology, Pisa, Italy

open access

Online first
Original article
Published online: 2022-03-14

Abstract

Introduction: Diastolic dysfunction (DD) is a diagnostic challenge in clinical practice.

Aim: The aim of our study was to evaluate the value of diastolic stress echocardiography (DSE) and heart failure (HF) biomarkers in patients with preserved left ventricle ejection fraction (LVEF) and HF symptoms.

Methods: All the consecutive patients with HF symptoms, preserved LVEF and suspected DD were examined in transthoracic echocardiography (TTE) and DSE using the protocol according to the ASE recommendations. Moreover, blood samples were taken 30 minutes before and after DSE for the following lab markers: N-terminal pro-B type natriuretic peptide (NT-proBNP), mid regional pro atrial natriuretic peptide (MR-proANP) and serum soluble ST2 receptor (ST2).

Results: The study group included 80 patients (mean [standard deviation, SD] age, 69 (8.1) years; 25% males) with dyspnea (New York Heart Association scale IIa — 53; IIb — 17; III — 10) and risk factors: hypertension (96%), diabetes (41%), obesity (56%) and known coronary artery disease (10%). The rest transthoracic echocardiographic (TTE) showed preserved systolic function (mean [SD], LVEF 61.1 [10.5]%) and normal or indeterminate diastolic function. DSE revealed positive result for diastolic dysfunction in 17 patients (21%). The receiver operating characteristic (ROC) analysis showed that age (the area under the curve [AUC], 0.725; P <0.01), left atrial volume indexed for body surface area [LAVI] rest (AUC, 0.722; P <0.01), E/e’ rest (AUC, 0.790; P <0.01) and baseline NT-proBNP (AUC, 0.713; P <0.01) predicted positive DSE. Other parameters, including body mass index, baseline E/A, DT or e’ were not predictive for DSE result.

Conclusions: DSE revealed diastolic dysfunction in 21% of study patients and improved the diagnostic value of echocardiography. Rest NT-proBNP, but not MR-proANP and ST2, provided a diagnostic value towards diastolic dysfunction.

Abstract

Introduction: Diastolic dysfunction (DD) is a diagnostic challenge in clinical practice.

Aim: The aim of our study was to evaluate the value of diastolic stress echocardiography (DSE) and heart failure (HF) biomarkers in patients with preserved left ventricle ejection fraction (LVEF) and HF symptoms.

Methods: All the consecutive patients with HF symptoms, preserved LVEF and suspected DD were examined in transthoracic echocardiography (TTE) and DSE using the protocol according to the ASE recommendations. Moreover, blood samples were taken 30 minutes before and after DSE for the following lab markers: N-terminal pro-B type natriuretic peptide (NT-proBNP), mid regional pro atrial natriuretic peptide (MR-proANP) and serum soluble ST2 receptor (ST2).

Results: The study group included 80 patients (mean [standard deviation, SD] age, 69 (8.1) years; 25% males) with dyspnea (New York Heart Association scale IIa — 53; IIb — 17; III — 10) and risk factors: hypertension (96%), diabetes (41%), obesity (56%) and known coronary artery disease (10%). The rest transthoracic echocardiographic (TTE) showed preserved systolic function (mean [SD], LVEF 61.1 [10.5]%) and normal or indeterminate diastolic function. DSE revealed positive result for diastolic dysfunction in 17 patients (21%). The receiver operating characteristic (ROC) analysis showed that age (the area under the curve [AUC], 0.725; P <0.01), left atrial volume indexed for body surface area [LAVI] rest (AUC, 0.722; P <0.01), E/e’ rest (AUC, 0.790; P <0.01) and baseline NT-proBNP (AUC, 0.713; P <0.01) predicted positive DSE. Other parameters, including body mass index, baseline E/A, DT or e’ were not predictive for DSE result.

Conclusions: DSE revealed diastolic dysfunction in 21% of study patients and improved the diagnostic value of echocardiography. Rest NT-proBNP, but not MR-proANP and ST2, provided a diagnostic value towards diastolic dysfunction.

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Keywords

diastolic stress test, stress echocardiography, NT-proBNP, MR-proANP, ST2

About this article
Title

Diastolic stress echocardiography and biomarkers in patients with preserved left ventricle ejection fraction and heart failure symptoms

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Online first

Article type

Original article

Published online

2022-03-14

Page views

83

Article views/downloads

68

DOI

10.33963/KP.a2022.0070

Pubmed

35285508

Keywords

diastolic stress test
stress echocardiography
NT-proBNP
MR-proANP
ST2

Authors

Andrzej Kubicius
Mariusz Bałys
Quirino Ciampi
Eugenio Picano
Zbigniew Gąsior
Maciej Haberka

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