Key result
Diastolic heart failure exhibits ~25% reduced basal septal strain versus controls, reflecting early longitudinal impairment.
Why the study?
Does the combination of NT-proBNP and Tissue Doppler Echocardiography improve diagnostic accuracy in diastolic and systolic heart failure?
Observational (n=137)
Single-blind
No
Does the combination of NT-proBNP and Tissue Doppler Echocardiography improve diagnostic accuracy in diastolic and systolic heart failure?
Absolute Event Rate: -18.5% vs -24.8%
p-value: p=<0.0001
In patients with preserved LV function, integrating multiple parameters including Tissue Doppler echocardiography and NT-proBNP is necessary for accurate classification of diastolic dysfunction.
Supports multimodal diastolic assessment with tissue Doppler and NT-proBNP in preserved EF; leaves open prospective validation of diagnostic accuracy.
BACKGROUND: The aim of this prospective study was to assess the diagnostic value of NT-proBNP and the concordance with Tissue Doppler Echocardiography (including strain and longitudinal displacement) in diastolic and systolic heart failure. METHODS AND RESULTS: 137 consecutive clinically stable patients were included (42 healthy controls, 43 with diastolic heart failure, 52 with systolic heart failure). In diastolic heart failure, basal septal strain was reduced (-24.8 +/- 8.1% vs. controls. -18.5 +/- 5.3%, p < 0.0001). In all patients with preserved systolic function, septal basal longitudinal displacement was impaired in patients with increased left-ventricular filling pressures (E/E' < 8: 13.5 mm +/- 3.3 mm vs. E/E' > 15: 8.5 mm +/- 2.3 mm, p = 0.001) parallel to NT-proBNP elevation (E/E' < 8: 45.8 pg/ml, IQR: 172.5 pg/ml vs. E/E' > 15: 402.0 pg/ml, IQR: 1337.2 pg/ml; p = 0.0007). In ROC analysis, NT-proBNP could detect patients with reduced left ventricular systolic function (LVEF >or= 55%) with a good diagnostic accuracy. However, the diagnostic accuracy of NT-proBNP to detect diastolic dysfunction was lower. CONCLUSION: Subtle changes of longitudinal myocardial function begin in diastolic heart failure and are further increased in systolic heart failure. In patients with preserved LV function, a complex approach with the integration of multiple parameters including Tissue Doppler echocardiography and NT-proBNP is necessary to classify patients.
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Knebel et al. (2008) conducted an observational in Diastolic and systolic heart failure (n=137). Diastolic heart failure vs. Healthy controls was evaluated on Basal septal strain (p=<0.0001). Patients with diastolic heart failure exhibited significantly reduced basal septal strain compared to healthy controls (-18.5% vs -24.8%, p<0.0001), reflecting early impairment of longitudinal myocardial function.
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