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- Title
Diastolic stress echocardiography and biomarkers in patients with preserved left ventricular ejection fraction and heart failure symptoms.
- Authors
Kubicius, Andrzej; Bałys, Mariusz; Ciampi, Quirino; Picano, Eugenio; Gąsior, Zbigniew; Haberka, Maciej
- Abstract
Background: Diastolic dysfunction (DD) is a diagnostic challenge in clinical practice. Aim: Our study aimed to evaluate the value of diastolic stress echocardiography (DSE) and heart failure (HF) biomarkers in patients with preserved left ventricular ejection fraction (LVEF) and HF symptoms. Methods: All the consecutive patients with HF symptoms, preserved LVEF, and suspected DD were examined on transthoracic echocardiography (TTE) and DSE using the protocol according to the American Society of Echocardiography recommendations. Moreover, blood samples were taken 30 minutes before and after DSE for the following lab markers: N-terminal pro-B type natriuretic peptide (NT-proBNP), mid regional pro-atrial natriuretic peptide (MR-proANP), and serum soluble ST2 receptor (ST2). Results: The study group included 80 patients (mean [standard deviation, SD] age, 69 (8.1) years; 25% males) with dyspnea (New York Heart Association classification IIa -- 53; IIb -- 17; III -- 10) and risk factors: hypertension (96%), diabetes (41%), obesity (56%), and known coronary artery disease (10%). The rest transthoracic echocardiography (TTE) showed preserved systolic function (mean [SD], LVEF 61.1 [10.5]%) and normal or indeterminate diastolic function. DSE revealed a positive result for diastolic dysfunction in 17 patients (21%). The receiver operating characteristic (ROC) analysis showed that age (the area under the curve [AUC], 0.725; P <0.01), left atrial volume indexed for body surface area [LAVI] rest (AUC, 0.722; P <0.01), E/e' rest (AUC, 0.790; P <0.01), and baseline NT-proBNP (AUC, 0.713; P <0.01) predicted positive DSE. Other parameters, including body mass index, baseline E/A, DT, or e' were not predictive of DSE results. Conclusions: DSE revealed diastolic dysfunction in 21% of study patients and improved the diagnostic value of echocardiography. Rest NT-proBNP, but not MR-proANP and ST2, provided a diagnostic value for diastolic dysfunction.
- Subjects
UNITED States; ECHOCARDIOGRAPHY; EXERCISE tests; BIOMARKERS; VENTRICULAR ejection fraction; LEFT ventricular dysfunction; TRANSESOPHAGEAL echocardiography; BLOOD collection; BODY surface area; DESCRIPTIVE statistics; NATRIURETIC peptides; RECEIVER operating characteristic curves; BODY mass index; HEART failure; MEDICAL societies
- Publication
Polish Heart Journal / Kardiologia Polska, 2022, Vol 80, Issue 5, p560
- ISSN
0022-9032
- Publication type
Article
- DOI
10.33963/KP.a2022.0070