Mitral annular motion parameters measured by pulsed-wave Doppler tissue imaging correlated strongly with plasma BNP levels (e.g., r=-0.82 for Em, P<0.001) for evaluating LV dysfunction.
Cross-Sectional (n=153)
Single-blind
Do echocardiographic measures of mitral annular motion correlate with BNP levels for detecting left ventricular dysfunction?
Parameters of mitral annular motion measured by pulsed-wave Doppler tissue imaging correlate strongly with plasma BNP levels, providing a sensitive and accurate tool for early diagnosis of LV dysfunction.
Effect estimate: r=-0.82 for Em, r=-0.7 for Sm
p-value: p=<0.001
BACKGROUND: Pulsed-wave (PW) Doppler tissue velocities of the mitral annulus correlate well with Left Ventricular (LV) diastolic(D) and systolic(S) functions. Brain natriuretic peptide (BNP) levels have been shown to be elevated in patients with symptomatic LV dysfunction (Dys) and correlate to the severity of symptoms and prognosis. OBJECTIVES: To validate the accuracy of mitral annular motion (MAM) assessed by Doppler Tissue Imaging (DTI) & M-mode Echocardiography (MME) as a surrogate for determination of LV function in comparison with BNP. METHODS: A series of 133 patients with a variety of cardiac pathologies referred for echocardiography and 20 healthy age & sex matched volunteers as a control group were included the study. Ejection fraction (EF) of LV, Doppler recordings of the mitral inflow, MME and PWDTI data (from each of 4 mitral annular sites, inferior, anterior, septum and lateral) were obtained. Mean peak (S) MAM velocity (Sm), mean annular early (D) velocity (Em) by PWDTI and mean mitral annular plane (S) excursion (MAPSE) by MME were calculated by averaging of values measured at each annular site. BNP levels were measured by a rapid immunoassay and blinded to cardiologist making the assessment of LV function. RESULTS: MAPSE 75 pg/ml has 98% sensitivity, 90% specificity & 97% accuracy for detection of LV Dys either (S,D, or both). BNP levels were significantly higher in patients with combined (S & D) Dys. Than those with only (S) Dys, the later group had significantly higher BNP levels than those with only (D) Dys. (1054.5 +/- 202.3 pg/ml vs. 500 +/- 39.9 pg/ml & 500 +/- 39.9 pg/ml vs. 215.3 +/- 100.9 pg/ml respectively, P < 0.001) & each were significantly higher than control group (12.3 +/- 5.7 pg/ml, P < 0.001). Significant correlations (P < 0.001 for all) were found between BNP levels and Em (r =-0.82), Sm (r=-0.7), early transmitral (E) to Em ratio (r=0.61), MAPSE (r=-0.54), LVEF(r=-0.64) & LV end D dimension (r=0.63). CONCLUSION: MME and PWDTI used for assessment of MAM are useful methods for evaluation of LV function but parameters measured by PWDTI correlate more strongly with plasma BNP levels than those measured by MME and provide a simple, sensitive, accurate and reproducible tool for early diagnosis of LV dysfunction.
ELNOAMANY et al. (Wed,) conducted a cross-sectional in Cardiac pathologies referred for echocardiography (n=153). Mitral annular motion assessed by Doppler Tissue Imaging and M-mode Echocardiography vs. Brain natriuretic peptide (BNP) levels was evaluated on Correlation between BNP levels and echocardiographic parameters of LV function (r=-0.82 for Em, r=-0.7 for Sm, p=<0.001). Mitral annular motion parameters measured by pulsed-wave Doppler tissue imaging correlated strongly with plasma BNP levels (e.g., r=-0.82 for Em, P<0.001) for evaluating LV dysfunction.
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