Skip Navigation

European Heart Journal 1999 20(19):1415-1423; doi:10.1053/euhj.1999.1633
Copyright © 1999 by the European Society of Cardiology.
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (37)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Fruhwald, F. M.
Right arrow Articles by Klein, W. W.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Fruhwald, F. M.
Right arrow Articles by Klein, W. W.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Natriuretic peptides in patients with diastolic dysfunction due to idiopathic dilated cardiomyopathy

F. M. Fruhwalda,f1, A. Fahrleitnerb, N. Watzingera, S. Fruhwaldc, H. Dobnigb, M. Schumachera, R. Maiera, R. Zweikera and W. W. Kleina

a Department of Internal Medicine, Division of Cardiology, Karl-Franzens University, Graz, Austria
b Department of Internal Medicine, Division of Endocrinology and Nuclear Medicine, Karl-Franzens University, Graz, Austria
c Department of Anaesthesia, Karl-Franzens University, Graz, Austria

revised March 8, 1999; accepted March 10, 1999 1999

Abstract

Aims The degree of systolic dysfunction does not always correlate with functional impairment in patients with congestive heart failure. In contrast, diastolic dysfunction correlates well with functional impairment. In heart failure, both elevation of N-terminal proatrial natriuretic peptide and B-type natriuretic peptide are markers of a poor prognosis.

Methods We investigated 32 patients (26 male, 6 female; mean age 55±2 years) with dilated cardiomyopathy and sinus rhythm. M-mode echocardiography and 2D-echocardiography were carried out in each patient. Pulsed-wave Doppler inflow signals were obtained and the following parameters were measured: maximal E wave and maximal A wave velocity, E/A ratio, E wave deceleration time, A wave deceleration time. Immediately after echocardiography blood samples were collected from patients in the supine position. N-terminal proANP and brain natriuretic peptide were measured using a radioimmuno assay.

Results The left ventricular ejection fraction was 34±1%, the left ventricular end-diastolic diameter on M-mode echocardiography was 68±1mm, while left atrial diameter was 45±1mm. Univariate analysis revealed a significant correlation between both left atrial diameter and ejection fraction and N-terminal proANP and brain natriuretic peptide. All transmitral Doppler parameters showed a significant correlation with N-terminal proANP and brain natriuretic peptide. On forward stepwise regression analysis, left atrial diameter and ejection fraction were able to predict both N-terminal proANP and brain natriuretic peptide. However, of the diastolic parameters only the E/A ratio remained significant. Mildly symptomatic patients differed significantly from severely symptomatic patients in all Doppler parameters. Mildly symptomatic patients had significantly lower levels of N-terminal proANP (0·571±0·079 vs 2·282±0·340nmol.l–1;P<0·001) and brain natriuretic peptide (51±14·8 vs 474·2± 86·8pg.ml–1;P<0·001).

Conclusion There is a close relationship between natriuretic peptides and diastolic Doppler parameters of left ventricular filling in patients with dilated cardiomyopathy. There is also a significant difference between patients with mild and severe functional impairment regarding both natriuretic peptides and transmitral Doppler parameters.

Key Words: Idiopathic dilated cardiomyopathy, functional impairment, transmitral Doppler filling, natriuretic peptides.

f1 Correspondence: Friedrich M. Fruhwald, MD, Division of Cardiology, Department of Internal Medicine, Auenbruggerplatz 15, A-8036 Graz, Austria.

References

  1. Gasch WH, Levine HJ, Quinones MA, Alexander JK. Left ventricular compliance: mechanisms and clinical implications. Am J Cardiol. 1976;38:645–653[CrossRef][ISI][Medline]
  2. Packer M. Abnormalities of diastolic function as a potential cause of exercise intolerance in chronic heart failure. Circulation. 1990;81:III78–86[Medline]
  3. Rossvol O, Hatle LK. Pulmonary venous flow velocities recorded by transthoracic Doppler ultrasound: relation to left ventricular diastolic pressures. J Am Coll Cardiol. 1993;21:1687–1696[Abstract]
  4. Giannuzzi P, Imparato A, Temporelli P. Doppler-derived mitral deceleration time of early filling as a strong predictor of pulmonary capillary wedge pressure in postinfarction patients with left ventricular systolic dysfunction. J Am Coll Cardiol. 1994;23:1630–1637[Abstract]
  5. Nishimura RA, Appleton CP, Redfield MM, Ilstrup DM, Holmes DR Jr, Tajik J. Noninvasive Doppler echocardiographic evaluation of left ventricular filling pressures in patients with cardiomyopathies: a simultaneous Doppler echocardiographic and cardiac catheterisation study. J Am Coll Cardiol. 1996;28:1226–1233[Abstract]
  6. Pozzoli M, Capomolla S, Pinna G, Cobelli F, Tavazzi L. Doppler echocardiography reliably predicts pulmonary artery wedge pressure in patients with chronic heart failure with and without mitral regurgitation. J Am Coll Cardiol. 1996;27:883–893[Abstract]
  7. Tenenbaum A, Motro M, Hod H, Kaplinsky E, Vered Z. Shortened Doppler-derived mitral A wave deceleration time: An important predictor of elevated left ventricular filling pressure. J Am Coll Cardiol. 1996;27:700–705[Abstract]
  8. Pinamonti B, DiLenarda A, Sinagra G, Camerini F. Restrictive left ventricular filling pattern in dilated cardiomyopathy assessed by Doppler echocardiography: clinical, echocardiographic and hemodynamic correlations and prognostic implications. J Am Coll Cardiol. 1993;22:808–815[Abstract]
  9. Werner GS, Schaefer C, Dirks R, Figulla HR, Kreuzer H. Prognostic value of Doppler echocardiographic assessment of left ventricular filling in idiopathic dilated cardiomyopathy. Am J Cardiol. 1994;73:792–798[CrossRef][ISI][Medline]
  10. Xie GY, Berk MR, Smith MD, Gurley JC, DeMaria AN. Prognostic value of Doppler transmitral flow patterns in patients with congestive heart failure. J Am Coll Cardiol. 1994;24:132–139[Abstract]
  11. Pinamonti B, Zecchin M, DiLenarda A, Gregori D, Sinagra G, Camerini F. Persistence of restrictive left ventricular filling pattern in dilated cardiomyopathy: an ominous prognostic sign. J Am Coll Cardiol. 1997;29:604–612[Abstract]
  12. Yu CM, Sanderson JE, Shum IOL. Diastolic dysfunction and natriuretic peptides in systolic heart failure. Higher ANP and BNP levels are associated with the restrictive filling pattern. Eur Heart J. 1996;17:1694–1702[Abstract/Free Full Text]
  13. Hall C, Rouleau JL, Moyè L. N-terminal proatrial natriuretic factor. An independent predictor of long-term prognosis after myocardial infarction. Circulation. 1994;89:1934–1942[Abstract/Free Full Text]
  14. Swedberg K, Eneroth P, Kjekshus J, Wilhelmsen L. Hormones regulating cardiovascular function and their relation to mortality. Circulation. 1990;82:1730–1736[Abstract/Free Full Text]
  15. Svanegaard J, Angelo-Nielsen K, Pindborg T. Plasma concentration of atrial natriuretic peptide at admission and risk of cardiac death in patients with acute myocardial infarction. Br Heart J. 1992;68:38–32
  16. Omland T, Aakvaag A, Bonarjee VV. Plasma brain natriuretic peptide as an indicator of left ventricular systolic function and long-term survival after acute myocardial infarction. Comparison with plasma atrial natriuretic peptide and N-terminal proatrial natriuretic peptide. Circulation. 1996;93:1963–1969[Abstract/Free Full Text]
  17. Lerman A, Gibbons RJ, Rodeheffer RJ. Circulating N-terminal atrial natriuretic peptide as a marker for symptomless left-ventricular dysfunction. Lancet. 1993;341:1105–1109[CrossRef][ISI][Medline]
  18. Bonarjee VV, Omland T, Nilsen DW, Caidahl K, Sundsfjord JA, Dickstein K. Plasma proatrial natriuretic factor (1-98) concentration after myocardial infarction: relation to indices of cardiac and renal function. Br Heart J. 1995;73:511–516[Abstract/Free Full Text]
  19. Dickstein K, Larsen AI, Bonarjee V, Thoresen M, Aarsland T, Hall C. Plasma proatrial natriuretic factor is predictive of clinical status in patients with congestive heart failure. Am J Cardiol. 1995;76:679–683[CrossRef][ISI][Medline]
  20. Cowie MR, Struthers AD, Wood DA. Value of natriuretic peptides in assessment of patients with possible new heart failure in primary care. Lancet. 1998;350:1349–1353
  21. McDonagh TA, Robb SD, Murdoch DR. Biochemical detection of left-ventricular systolic dysfunction. Lancet. 1998;351:9–13[CrossRef][ISI][Medline]
  22. Fruhwald FM, Watzinger N, Fruhwald S, Schumacher M, Zweiker R, Klein W. Diastolic filling in idiopathic dilated cardiomyopathy shows a good correlation to heart rate and ejection fraction but not to blood pressure as in healthy subjects (letter). Eur Heart J. 1997;18:348–349[Free Full Text]
  23. Fruhwald FM, Watzinger N, Schumacher M, Zweiker R, Pokan R, Klein W. Das Ausmaß der diastolischen Dysfunktion und dessen Korrelation zur subjektiven Leistungseinschränkung bei Patienten mit dilatativer. CMP. Dtsch Med Wschr. 1997;122:845–848[Medline]
  24. Richardson P, McKenna W, Bristow M. Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the definition and classification of cardiomyopathies. Circulation. 1996;93:841–842[Free Full Text]
  25. Giannuzzi P, Temporelli PL, Bosimini E. Independent and incremental prognostic value of Doppler-derived mitral deceleration time of early filling in both symptomatic and asymptomatic patients with left ventricular dysfunction. J Am Coll Cardiol. 1996;28:383–390[Abstract]
  26. Nishimura RA, Abel MD, Hatle LK, Tajik AJ. Assessment of diastolic function of the heart: background and current applications of Doppler echocardiography. Part II. Clinical studies. Mayo Clin Proc. 1989;64:181–204[ISI][Medline]
  27. Rihal CS, Nishimura RA, Hatle LK, Bailey KR, Tajik AJ. Systolic and diastolic dysfunction in patients with clinical diagnosis of dilated cardiomyopathy. Relation to symptoms and prognosis. Circulation. 1994;90:2772–2779[Abstract/Free Full Text]
  28. Xie GY, Berk MR, Smith MD, DeMaria AN. Relation of Doppler transmitral flow patterns to functional status in congestive heart failure. Am Heart J. 1996;131:766–771[CrossRef][ISI][Medline]
  29. Little, WC, Braunwald, E, Assessment of cardiac function: evaluation of diastolic performance, Braunwald, E, Heart disease, a textbook of cardiovascular medicine, Philadelphia, WB Saunders Company, 1997, 435, 8
  30. Yamamoto K, Nishimura RA, Chaliki HP, Appleton CP, Holmes DR Jr, Redfield MM. Determination of left ventricular filling pressure by Doppler echocardiography in patients with coronary artery disease: Critical role of left ventricular systolic function. J Am Coll Cardiol. 1997;30:1819–1826[Abstract]
  31. Motwani JG, McAlpine H, Kennedy N, Struthers AD. Plasma brain natriuretic peptide as an indicator for angiotensin-converting-enzyme inhibition after myocardial infarction. Lancet. 1993;341:1109–1113[CrossRef][ISI][Medline]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 J. Thorac. Cardiovasc. Surg.Home page
R. Walsh, C. Boyer, J. LaCorte, V. Parnell, C. Sison, D. Chowdhury, and K. Ojamaa
N-terminal B-type natriuretic peptide levels in pediatric patients with congestive heart failure undergoing cardiac surgery
J. Thorac. Cardiovasc. Surg., January 1, 2008; 135(1): 98 - 105.
[Abstract] [Full Text] [PDF]

Home page
 Clin. Chem.Home page
M. Codognotto, A. Piccoli, M. Zaninotto, M. Mion, M. Plebani, U. Vertolli, F. Tona, L. Ruzza, A. Barchita, and G. M. Boffa
Renal Dysfunction Is a Confounder for Plasma Natriuretic Peptides in Detecting Heart Dysfunction in Uremic and Idiopathic Dilated Cardiomyopathies
Clin. Chem., December 1, 2007; 53(12): 2097 - 2104.
[Abstract] [Full Text] [PDF]

Home page
 Clin. Chem.Home page
A. Hammerer-Lercher, W. Ludwig, G. Falkensammer, S. Muller, E. Neubauer, B. Puschendorf, O. Pachinger, and J. Mair
Natriuretic Peptides as Markers of Mild Forms of Left Ventricular Dysfunction: Effects of Assays on Diagnostic Performance of Markers
Clin. Chem., July 1, 2004; 50(7): 1174 - 1183.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
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]

Home page
 Endocr. Rev.Home page
H. Ruskoaho
Cardiac Hormones as Diagnostic Tools in Heart Failure
Endocr. Rev., June 1, 2003; 24(3): 341 - 356.
[Abstract] [Full Text] [PDF]

Home page
 BMJHome page
F D R Hobbs, R C Davis, A K Roalfe, R Hare, M K Davies, and J E Kenkre
Reliability of N-terminal pro-brain natriuretic peptide assay in diagnosis of heart failure: cohort study in representative and high risk community populations
BMJ, June 22, 2002; 324(7352): 1498 - 1498.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
L. Cabanes, B. Richaud-Thiriez, Y. Fulla, F. Heloire, C. Vuillemard, S. Weber, and D. Dusser
Brain Natriuretic Peptide Blood Levels in the Differential Diagnosis of Dyspnea
Chest, December 1, 2001; 120(6): 2047 - 2050.
[Abstract] [Full Text] [PDF]

Home page
 J. Am. Soc. Nephrol.Home page
K. Amann, A. Simonaviciene, T. Medwedewa, A. Koch, S. Orth, M.-L. Gross, C. Haas, A. Kuhlmann, W. Linz, B. Scholkens, et al.
Blood Pressure-Independent Additive Effects of Pharmacologic Blockade of the Renin-Angiotensin and Endothelin Systems on Progression in a Low-Renin Model of Renal Damage
J. Am. Soc. Nephrol., December 1, 2001; 12(12): 2572 - 2584.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
D.P. Nicholls and M.S. Riley
Measuring cardiac power output--the acid test
Eur. Heart J., August 2, 2001; 22(16): 1368 - 1370.
[PDF]

Home page
 Eur Heart JHome page
H. Oxenham and N. Sharpe
Prognostic stratification in heart failure: what's the point?
Eur. Heart J., November 2, 2000; 21(22): 1815 - 1816.
[PDF]

Home page
 Eur Heart JHome page
A.D. Struthers
Editorials: How to use natriuretic peptide levels for diagnosis and prognosis
Eur. Heart J., October 1, 1999; 20(19): 1374 - 1375.
[PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (37)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Fruhwald, F. M.
Right arrow Articles by Klein, W. W.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Fruhwald, F. M.
Right arrow Articles by Klein, W. W.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?