gms | German Medical Science

Background: We investigated N-terminal pro-B type natriuretic peptide (NT-proBNP) in its effectiveness in the diagnostic of diastolic dysfunction compared to conventional and tissue Doppler echocardiography (TDI) and invasive heart catheterisation.

Methods: 88 patients with isolated diastolic dysfunction and preserved LVEF and 80 controls were examined by conventional echocardiography (transmitral inflow ratio (E/A), deceleration time (DT), isovolumic relaxation time (IVRT)), tissue Doppler (E`/Am`) and right/left heart catheterization (end-diastolic pressure (LVEDP), dP/dtmin, Tau, pulmonary wedge pressure (PCP)). Simultaneously plasma NT-proBNP levels (Elecsys 2010, Roche Diagnostics, Germany) were determined.

Results: Patients (56 men 41 w, 56 m) with diastolic dysfunction had significantly elevated NT-pro BNP levels compared to controls (214.72 [106.49-386.21] vs. 52.34 [31.98-74.35] pg/ml, p<0.0001). According to ROC analysis, the invasive parameters LVEDP and PCP were the most specific but with low sensitivity. Reliability of NT-proBNP was similar to TDI and higher compared to conventional echocardiography (AUC 0.86 vs. 0.73) and had the highest negative predictive value of all parameters (96%). NT-pro-BNP plasma levels also correlated with the echo-classes of diastolic dysfunction. Linear regressions analysis confirmed it to be a strong predictor of diastolic dysfunction with an Odds Ratio 9.75.

Conclusions: Neither of echocardiography method reaches the reliability of NT-proBNP in detecting isolated diastolic dysfunction. Thus, ProBNP serves as an accurate plasma biomarker to detect diastolic dysfunction within patients with previously estimated preserved systolic function.