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European Heart Journal Advance Access originally published online on July 13, 2005
European Heart Journal 2005 26(21):2277-2284; doi:10.1093/eurheartj/ehi406
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

The role of NT-proBNP in the diagnostics of isolated diastolic dysfunction: correlation with echocardiographic and invasive measurements

Carsten Tschöpe*,{dagger}, Mario Kasner{dagger}, Dirk Westermann, Regina Gaub, Wolfgang C. Poller and Heinz-Peter Schultheiss

Department of Cardiology and Pneumology, Charité—University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany

Received 11 February 2005; revised 14 June 2005; accepted 16 June 2005; online publish-ahead-of-print 13 July 2005.

* Corresponding author. Tel: +49 30 8445 4802; fax: +49 30 7871 7823. E-mail address: ctschoepe{at}yahoo.com

Aims Diastolic heart failure is a frequent entity but difficult to diagnose. N-terminal pro-B type natriuretic peptide (NT-proBNP) was therefore investigated as a possible non-invasive parameter to diagnose isolated diastolic dysfunction.

Methods and results Sixty-eight symptomatic patients with isolated diastolic dysfunction and preserved left ventricular ejection fraction (LVEF) (≥50%) and 50 patients with regular left ventricular (LV) function were examined by conventional echocardiography, tissue Doppler imaging (TDI), and left and right heart catheterization. Plasma NT-proBNP levels were determined simultaneously. Median NT-proBNP plasma levels were elevated [189.54 pg/mL (86.16–308.27) vs. 51.89 pg/mL (29.94–69.71); P<0.001] and increased with greater severity of the diastolic dysfunction (R=0.67, P<0.001). According to the recevier operating characteristic analysis, LV end-diastolic pressure [area under the curve (AUC) 0.84] was the most specific parameter, which had a low sensitivity (61%), however. The reliability of NT-proBNP was similar to TDI indices (AUC 0.83 vs. 0.81) and improved when compared with conventional echocardiography (AUC 0.59–0.70). NT-proBNP levels had the best negative predictive value of all methods (94%) and correlated strongly with indices of LV filling pressure, as determined by invasive measurements. Multivariable linear regression analysis confirmed NT-proBNP as an independent predictor of diastolic dysfunction with an Odds ratio of 1.2 (1.1–1.4, CI 95%) for every unit increase of NT-proBNP.

Conclusion NT-proBNP can reliably detect the presence of isolated diastolic dysfunction in symptomatic patients and is an useful tool to rule out patients with reduced exercise tolerance of non-cardiac origin.

Key Words: Left ventricular diastolic dysfunction • N-terminal pro-B type natriuretic peptide • Heart failure • Biomarker


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