Department of Cardiology and Pneumology, Charité-University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany.
Int J Cardiol. 2011 May 19;149(1):23-9. doi: 10.1016/j.ijcard.2009.11.035. Epub 2010 Jan 6.
Conventional echocardiography has limited accuracy in detecting diastolic dysfunction and NT-proBNP is known to be a reliable biomarker to rule out heart failure. Therefore NT-proBNP on top to conventional mitral flow Doppler might improve the diagnostic of diastolic dysfunction in patients with heart failure despite normal EF (HFNEF) without using tissue Doppler.
Diastolic function of 46 patients with HFNEF was determined by pressure-volume loop obtained by conductance-catheter measurements. LV stiffness correlated with the amount of collagen types I and III analyzed from endomyocardial biopsies (EMBs). NT-proBNP plasma levels correlated with LV stiffness, LVEDP and the collagen amount from EMBs (p<0.01). In another set of patients with HFNEF (n=107, 53 [45-62] years), diastolic dysfunction was confirmed by left and/or right heart catheterization. Their Doppler indices and plasma marker NT-proBNP values were compared with those of 73 controls (186 [70-342] vs 54[30-75] pg/ml, p<0.001). Mitral flow Doppler was impaired in 70/107 (65%) of the HFNEF. When additional criterium NT-proBNP>125 pg/ml was used 96/107 (90%) patients with impaired diastolic function were recognized. Sensitivity of tissue Doppler indices E'/A' and E/E' were improved by 4-6% using NT-proBNP on top. NT-proBNP recognized HFNEF patients with higher hospitalization rate indicated by phone questionnaire, whereas Doppler indices alone did not.
Plasma NT-proBNP levels are associated with increased LV stiffness and cardiac collagen content. On top measurements of plasma NT-proBNP improve the echocardiography diagnostic of diastolic function and prognostic of rehospitalization in HFNEF.
常规超声心动图在检测舒张功能障碍方面的准确性有限，而 NT-proBNP 被认为是排除心力衰竭的可靠生物标志物。因此，在不使用组织多普勒的情况下，在常规二尖瓣血流多普勒的基础上加上 NT-proBNP 可能会提高心力衰竭伴射血分数正常（HFNEF）患者舒张功能障碍的诊断准确性。
通过电导导管测量获得的压力-容积环来确定 46 例 HFNEF 患者的舒张功能。左心室僵硬度与从心内膜心肌活检（EMB）分析的胶原 I 和 III 类型的数量相关。NT-proBNP 血浆水平与左心室僵硬度、LVEDP 和 EMB 中的胶原量相关（p<0.01）。在另一组 HFNEF 患者（n=107，53[45-62]岁）中，通过左心和/或右心导管检查确认舒张功能障碍。将他们的多普勒指数和血浆标志物 NT-proBNP 值与 73 名对照者（186[70-342]比 54[30-75]pg/ml，p<0.001）进行比较。在 70/107（65%）HFNEF 患者中，二尖瓣血流多普勒受损。当使用附加标准 NT-proBNP>125pg/ml 时，96/107（90%）舒张功能障碍患者被识别。使用 NT-proBNP 可使组织多普勒指数 E'/A'和 E/E'的敏感性提高 4-6%。NT-proBNP 识别出 HFNEF 患者的住院率较高，这是通过电话问卷调查得出的，而单独的多普勒指数则无法识别。
血浆 NT-proBNP 水平与左心室僵硬度和心脏胶原含量增加有关。在常规超声心动图的基础上加上 NT-proBNP 可提高 HFNEF 患者舒张功能的诊断准确性和再住院的预后。
