The role of NT-proBNP in the diagnostics of isolated diastolic dysfunction: correlation with echocardiographic and invasive measurements.
OBJECTIVE
Diastolic heart failure is a frequent entity but difficult to diagnose. N-terminal pro-B type natriuretic peptide (NT-proBNP) was therefore investigated as a possible non-invasive parameter to diagnose isolated diastolic dysfunction.


RESULTS
Sixty-eight symptomatic patients with isolated diastolic dysfunction and preserved left ventricular ejection fraction (LVEF) (> or =50%) and 50 patients with regular left ventricular (LV) function were examined by conventional echocardiography, tissue Doppler imaging (TDI), and left and right heart catheterization. Plasma NT-proBNP levels were determined simultaneously. Median NT-proBNP plasma levels were elevated [189.54 pg/mL (86.16-308.27) vs. 51.89 pg/mL (29.94-69.71); P<0.001] and increased with greater severity of the diastolic dysfunction (R=0.67, P<0.001). According to the recevier operating characteristic analysis, LV end-diastolic pressure [area under the curve (AUC) 0.84] was the most specific parameter, which had a low sensitivity (61%), however. The reliability of NT-proBNP was similar to TDI indices (AUC 0.83 vs. 0.81) and improved when compared with conventional echocardiography (AUC 0.59-0.70). NT-proBNP levels had the best negative predictive value of all methods (94%) and correlated strongly with indices of LV filling pressure, as determined by invasive measurements. Multivariable linear regression analysis confirmed NT-proBNP as an independent predictor of diastolic dysfunction with an Odds ratio of 1.2 (1.1-1.4, CI 95%) for every unit increase of NT-proBNP.


CONCLUSIONS
NT-proBNP can reliably detect the presence of isolated diastolic dysfunction in symptomatic patients and is an useful tool to rule out patients with reduced exercise tolerance of non-cardiac origin.
Tschöpe
Carsten
C
Department of Cardiology and Pneumology, Charité--University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany. ctschoepe@yahoo.com
Kasner
Mario
M
Westermann
Dirk
D
Gaub
Regina
R
Poller
Wolfgang C
WC
Schultheiss
Heinz-Peter
HP
D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D003971:Diastole; D004452:Echocardiography / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011446:Prospective Studies; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000503:physiopathology
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain