Characterization of left ventricular filling abnormalities and its relation to elevated plasma brain natriuretic peptide level in acute to chronic diastolic heart failure.
BACKGROUND
Although Doppler left ventricular (LV) filling abnormalities have been extensively analyzed in patients with systolic heart failure (SHF), they have not yet been well characterized in patients with acute to chronic diastolic heart failure (DHF) in the light of plasma brain natriuretic peptide (BNP) levels.


RESULTS
In 25 patients presenting with acute DHF and 25 with acute SHF, echo Doppler parameters and plasma BNP levels were obtained on admission and in the chronic stage. The mitral E/A ratio was lower in DHF patients than in SHF patients in the acute stage (1.3 +/-0.4 vs 1.8+/-0.9, p<0.05), and in the chronic stage of DHF the ratio decreased with plasma BNP level, but plasma BNP level was still greater than 100 pg/ml in 15 patients (60%). Among patients with DHF the plasma BNP level did not correlate with the mitral E/A ratio or deceleration time (r=0,25, p=NS; r=0,23, p=NS), but did with estimated pulmonary artery systolic pressure (r=0.64, p<0.01).


CONCLUSIONS
A restrictive mitral flow velocity pattern is observed in only 25% of patients with DHF, so it is particularly important to recognize pseudonormalization in those with possible DHF. Persistently elevated plasma BNP level is not primarily caused by LV diastolic dysfunction, but by secondary alteration for hemodynamic adjustment (elevated LV end-diastolic pressure) in patients with DHF.
Nakao
Shinji
S
Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
Goda
Akiko
A
Yuba
Masao
M
Otsuka
Misato
M
Matsumoto
Mika
M
Yoshida
Chikako
C
Ohyanagi
Mitsumasa
M
Naito
Yoshiro
Y
Lee
Masaaki
M
Tsujino
Takeshi
T
Masuyama
Tohru
T
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D002908:Chronic Disease; D015150:Echocardiography, Doppler; D005260:Female; D054144:Heart Failure, Diastolic / Q000097:blood* / Q000000981:diagnostic imaging / Q000503:physiopathology; D054143:Heart Failure, Systolic / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D016277:Ventricular Function, Left
D020097:Natriuretic Peptide, Brain