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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R. J. Rodeheffer Measuring plasma B-type natriuretic peptide in heart failure: Good to go in 2004? J. Am. Coll. Cardiol., August 18, 2004; 44(4): 740 - 749. [Abstract] [Full Text] [PDF]
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P. M. Mottram, B. Haluska, R. Leano, D. Cowley, M. Stowasser, and T. H. Marwick Effect of Aldosterone Antagonism on Myocardial Dysfunction in Hypertensive Patients With Diastolic Heart Failure Circulation, August 3, 2004; 110(5): 558 - 565. [Abstract] [Full Text] [PDF]
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M. M. Redfield, R. J. Rodeheffer, S. J. Jacobsen, D. W. Mahoney, K. R. Bailey, and J. C. Burnett Jr Plasma Brain Natriuretic Peptide to Detect Preclinical Ventricular Systolic or Diastolic Dysfunction: A Community-Based Study Circulation, June 29, 2004; 109(25): 3176 - 3181. [Abstract] [Full Text] [PDF]
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M.F.V. Sim, S. F. Ho, M.S. O'Mahony, J. A. Steward, M. Buchalter, and M. Burr European reference values for Doppler indices of left ventricular diastolic filling Eur J Heart Fail, June 1, 2004; 6(4): 433 - 438. [Abstract] [Full Text] [PDF]
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J. Hokamaki, H. Kawano, M. Yoshimura, H. Soejima, S. Miyamoto, I. Kajiwara, S. Kojima, T. Sakamoto, S. Sugiyama, N. Hirai, et al. Urinary biopyrrins levels are elevated in relation to severity of heart failure J. Am. Coll. Cardiol., May 19, 2004; 43(10): 1880 - 1885. [Abstract] [Full Text] [PDF]
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T. Jernberg, S. James, B. Lindahl, M. Stridsberg, P. Venge, and L. Wallentin NT-proBNP in unstable coronary artery disease--experiences from the FAST, GUSTO IV and FRISC II trials Eur J Heart Fail, March 15, 2004; 6(3): 319 - 325. [Abstract] [Full Text] [PDF]
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M. D. Thomas, K. F. Fox, A. J.S. Coats, and G. C. Sutton The epidemiological enigma of heart failure with preserved systolic function Eur J Heart Fail, March 1, 2004; 6(2): 125 - 136. [Abstract] [Full Text] [PDF]
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T. J. Wang, M. G. Larson, D. Levy, E. J. Benjamin, E. P. Leip, T. Omland, P. A. Wolf, and R. S. Vasan Plasma Natriuretic Peptide Levels and the Risk of Cardiovascular Events and Death N. Engl. J. Med., February 12, 2004; 350(7): 655 - 663. [Abstract] [Full Text] [PDF]
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R. W. Troughton, D. L. Prior, J. J. Pereira, M. Martin, A. Fogarty, A. Morehead, T. G. Yandle, A. M. Richards, R. C. Starling, J. B. Young, et al. Plasma B-type natriuretic peptide levels in systolic heart failure: importance of left ventricular diastolic function and right ventricular systolic function J. Am. Coll. Cardiol., February 4, 2004; 43(3): 416 - 422. [Abstract] [Full Text] [PDF]
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S. de Denus, C. Pharand, and D. R. Williamson Brain Natriuretic Peptide in the Management of Heart Failure: The Versatile Neurohormone Chest, February 1, 2004; 125(2): 652 - 668. [Abstract] [Full Text] [PDF]
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B. K. Gehlbach and E. Geppert The Pulmonary Manifestations of Left Heart Failure Chest, February 1, 2004; 125(2): 669 - 682. [Abstract] [Full Text] [PDF]
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S. A. Jortani, S. D. Prabhu, and R. Valdes Jr Strategies for Developing Biomarkers of Heart Failure Clin. Chem., February 1, 2004; 50(2): 265 - 278. [Abstract] [Full Text] [PDF]
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H. Yamaguchi, J. Yoshida, K. Yamamoto, Y. Sakata, T. Mano, N. Akehi, M. Hori, Y.-J. Lim, M. Mishima, and T. Masuyama Elevation of plasma brain natriuretic peptide is a hallmark of diastolic heart failure independent of ventricular hypertrophy J. Am. Coll. Cardiol., January 7, 2004; 43(1): 55 - 60. [Abstract] [Full Text] [PDF]
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A. Prahash and T. Lynch B-Type Natriuretic Peptide: A Diagnostic, Prognostic, and Therapeutic Tool in Heart Failure Am. J. Crit. Care., January 1, 2004; 13(1): 46 - 53. [Abstract] [Full Text] [PDF]
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A. Clerico and M. Emdin Diagnostic Accuracy and Prognostic Relevance of the Measurement of Cardiac Natriuretic Peptides: A Review Clin. Chem., January 1, 2004; 50(1): 33 - 50. [Abstract] [Full Text] [PDF]
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K. Bibbins-Domingo, M. Ansari, N. B. Schiller, B. Massie, and M. A. Whooley B-Type Natriuretic Peptide and Ischemia in Patients With Stable Coronary Disease: Data From the Heart and Soul Study Circulation, December 16, 2003; 108(24): 2987 - 2992. [Abstract] [Full Text] [PDF]
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T. Jernberg, B. Lindahl, A. Siegbahn, B. Andren, G. Frostfeldt, B. Lagerqvist, M. Stridsberg, P. Venge, and L. Wallentin N-terminal pro-brain natriuretic peptide in relation to inflammation, myocardial necrosis, and the effect of an invasive strategy in unstable coronary artery disease J. Am. Coll. Cardiol., December 3, 2003; 42(11): 1909 - 1916. [Abstract] [Full Text] [PDF]
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J. E. Moller, B. Brendorp, M. Ottesen, L. Kober, K. Egstrup, S. H. Poulsen, and C. Torp-Pedersen Congestive heart failure with preserved left ventricular systolic function after acute myocardial infarction: clinical and prognostic implications Eur J Heart Fail, December 1, 2003; 5(6): 811 - 819. [Abstract] [Full Text] [PDF]
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Y. Ootaki, M. Yamaguchi, N. Yoshimura, S. Oka, M. Yoshida, and T. Hasegawa Secretion of A-type and B-type natriuretic peptides into the bloodstream and pericardial space in children with congenital heart disease J. Thorac. Cardiovasc. Surg., November 1, 2003; 126(5): 1411 - 1416. [Abstract] [Full Text] [PDF]
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A. S. Maisel, J. McCord, R. M. Nowak, J. E. Hollander, A. H. B. Wu, P. Duc, T. Omland, A. B. Storrow, P. Krishnaswamy, W. T. Abraham, et al. Bedside B-Type natriuretic peptide in the emergency diagnosis of heart failure with reduced or preserved ejection fraction: Results from the Breathing Not Properly Multinational Study J. Am. Coll. Cardiol., June 4, 2003; 41(11): 2010 - 2017. [Abstract] [Full Text] [PDF]
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B. M. Massie Natriuretic peptide measurements for the diagnosis of "nonsystolic" heart failure: Good news and bad J. Am. Coll. Cardiol., June 4, 2003; 41(11): 2018 - 2021. [Full Text] [PDF]
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