Key result
Rest NT-proBNP predicted exercise-induced diastolic dysfunction on stress echocardiography with an AUC of 0.713, whereas MR-proANP and ST2 did not provide diagnostic value.
Why the study?
Diastolic dysfunction is a diagnostic challenge in clinical practice, prompting evaluation of the value of diastolic stress echocardiography and heart failure biomarkers in patients with preserved LVEF and heart failure symptoms.
Does diastolic stress echocardiography and biomarker measurement improve the diagnosis of diastolic dysfunction in patients with preserved LVEF and heart failure symptoms?
Cross-Sectional (n=80)
Single-blind
No
Does diastolic stress echocardiography and biomarker measurement improve the diagnosis of diastolic dysfunction in patients with preserved LVEF and heart failure symptoms?
Effect estimate: AUC 0.713 (95% CI 0.601-0.809)
p-value: p=<0.01
Diastolic stress echocardiography unmasks diastolic dysfunction in 21% of patients with preserved LVEF and inconclusive rest echocardiography, with rest NT-proBNP serving as a significant predictor of exercise-induced diastolic dysfunction.
May identify patients for DSE via NT-proBNP; hypothesis-generating for diagnostic algorithms in preserved LVEF HF.
BACKGROUND: Diastolic dysfunction (DD) is a diagnostic challenge in clinical practice. AIM: Our study aimed to evaluate the value of diastolic stress echocardiography (DSE) and heart failure (HF) biomarkers in patients with preserved left ventricular ejection fraction (LVEF) and HF symptoms. METHODS: All the consecutive patients with HF symptoms, preserved LVEF, and suspected DD were examined on transthoracic echocardiography (TTE) and DSE using the protocol according to the American Society of Echocardiography recommendations. Moreover, blood samples were taken 30 minutes before and after DSE for the following lab markers: N-terminal pro-B type natriuretic peptide (NT-proBNP), mid regional pro-atrial natriuretic peptide (MR-proANP), and serum soluble ST2 receptor (ST2). RESULTS: The study group included 80 patients (mean [standard deviation, SD] age, 69 (8.1) years; 25% males) with dyspnea (New York Heart Association classification IIa - 53; IIb - 17; III - 10) and risk factors: hypertension (96%), diabetes (41%), obesity (56%), and known coronary artery disease (10%). The rest transthoracic echocardiography (TTE) showed preserved systolic function (mean [SD], LVEF 61.1 [10.5]%) and normal or indeterminate diastolic function. DSE revealed a positive result for diastolic dysfunction in 17 patients (21%). The receiver operating characteristic (ROC) analysis showed that age (the area under the curve [AUC], 0.725; P < 0.01), left atrial volume indexed for body surface area [LAVI] rest (AUC, 0.722; P < 0.01), E/e' rest (AUC, 0.790; P < 0.01), and baseline NT-proBNP (AUC, 0.713; P < 0.01) predicted positive DSE. Other parameters, including body mass index, baseline E/A, DT, or e' were not predictive of DSE results. CONCLUSIONS: DSE revealed diastolic dysfunction in 21% of study patients and improved the diagnostic value of echocardiography. Rest NT-proBNP, but not MR-proANP and ST2, provided a diagnostic value for diastolic dysfunction.
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A 2022 study conducted a cross-sectional in Heart failure symptoms with preserved left ventricular ejection fraction and suspected diastolic dysfunction (n=80). Rest NT-proBNP was evaluated on Prediction of positive diastolic stress echocardiography (diastolic dysfunction) (AUC 0.713, 95% CI 0.601-0.809, p=<0.01). Rest NT-proBNP predicted exercise-induced diastolic dysfunction on stress echocardiography with an AUC of 0.713, whereas MR-proANP and ST2 did not provide diagnostic value.
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