Circulation. 2002;105:595-601
doi: 10.1161/hc0502.103010
doi: 10.1161/hc0502.103010
(Circulation. 2002;105:595.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
Utility of B-Natriuretic Peptide in Detecting Diastolic Dysfunction
Comparison With Doppler Velocity Recordings
From the Division of Cardiology and the Department of Medicine, Veteran’s Affairs Medical Center, and University of California, San Diego.
Correspondence to Alan Maisel, MD, VAMC Cardiology 111-A, 3350 La Jolla Village Dr, San Diego, CA 92161. E-mail amaisel{at}ucsd.edu
Background— Although Doppler echocardiography has been used to identify abnormal left ventricular (LV) diastolic filling dynamics, inherent limitations suggest the need for additional measures of diastolic dysfunction. Because data suggest that B-natriuretic peptide (BNP) partially reflects ventricular pressure, we hypothesized that BNP levels could predict diastolic abnormalities in patients with normal systolic function.
Methods and Results— We studied 294 patients referred for echocardiography to evaluate ventricular function. Patients with abnormal systolic function were excluded. Cardiologists making the assessment of LV function were blinded to BNP levels. Patients were classified as normal, impaired relaxation, pseudonormal, and restrictivelike filling patterns. Patients diagnosed with evidence of abnormal LV diastolic function (n=119) had a mean BNP concentration of 286±31 pg/mL; those in the normal LV group (n=175) had a mean BNP concentration of 33±3 pg/mL. Patients with restrictivelike filling patterns on echocardiography had the highest BNP levels (408±66 pg/mL), and patients with symptoms had higher BNP levels in all diastolic filling patterns. The area under the receiver-operating characteristic curve for BNP to detect any diastolic dysfunction was 0.92 (95% CI, 0.87 to 0.95; P<0.001). A BNP value of 62 pg/mL had a sensitivity of 85%, a specificity of 83%, and an accuracy of 84% for detecting diastolic dysfunction.
Conclusions— A rapid assay for BNP can reliably detect the presence of diastolic abnormalities on echocardiography. In patients with normal systolic function, elevated BNP levels and diastolic filling abnormalities might help to reinforce the diagnosis diastolic dysfunction.
Key Words: echocardiography • peptides • diastole
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