Preclinical systolic and diastolic dysfunction assessed by tissue Doppler imaging is associated with elevated plasma pro-B-type natriuretic peptide concentrations.
BACKGROUND
Heart failure is a major public health problem. To improve its grave prognosis, early identification of cardiac dysfunction is mandatory. Conventional echocardiography is not suitable for this. Tissue Doppler imaging (TDI), however, could be so.


RESULTS
Within a large community-based population-study (n = 1012), cardiac function was evaluated by conventional echocardiography (left ventricular hypertrophy, dilatation, systolic, and severe diastolic dysfunction), TDI, and plasma proBNP. Averages of peak systolic (s'), early diastolic (e'), and late diastolic (a') velocities from 6 mitral annular sites were used. TDI was furthermore quantified by a combined index (eas-index) of diastolic and systolic performance: e'/(a' x s'). Compared with controls, persons with elevated plasma proBNP concentrations (n = 100) displayed lower systolic and diastolic performance by TDI, in terms of lower s' (P = 0.017) and a' (P < .001), and higher e'/a' (P = .002) and eas-index (P < .001). This pattern remained significant after multivariable adjustment for age, sex, body mass index, heart rate, estimated glomerular filtration rate, hypertension, diabetes, ischemic heart disease, and conventional echocardiography. Furthermore, TDI provided incremental information over conventional echocardiography in predicting elevated plasma proBNP concentrations.


CONCLUSIONS
Preclinical systolic and diastolic dysfunction by TDI is associated with elevated plasma proBNP levels, even when conventional echocardiography is normal.
Mogelvang
Rasmus
R
Copenhagen City Heart Study, Epidemiological Research Unit, Bispebjerg Hospital, Copenhagen, Denmark. Rasmus.Mogelvang@get2net.dk
Goetze
Jens P
JP
Pedersen
Sune A
SA
Olsen
Niels T
NT
Marott
Jacob L
JL
Schnohr
Peter
P
Sogaard
Peter
P
Jensen
Jan S
JS
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000097:blood / Q000000981:diagnostic imaging; D015331:Cohort Studies; D003971:Diastole / Q000502:physiology; D004452:Echocardiography / Q000379:methods / Q000592:standards; D018618:Echocardiography, Doppler, Color / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D012111:Residence Characteristics; D013599:Systole / Q000502:physiology
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain