Document Detail


Early detection of left ventricular dysfunction by Doppler tissue imaging and N-terminal pro-B-type natriuretic peptide in patients with symptomatic severe aortic stenosis.
MedLine Citation:
PMID:  17628412     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Patients with severe aortic stenosis (AS) require valve replacement before development of irreversible left ventricular (LV) dysfunction. It has been postulated that Doppler tissue imaging (DTI) parameters are more sensitive to detect subtle LV dysfunction compared with conventional echocardiographic parameters. OBJECTIVE: We sought to assess early LV dysfunction with DTI-derived echocardiographic parameters and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with severe AS and normal LV ejection fraction. METHODS: A total of 29 patients (mean age 65 +/- 12 years, 15 male) with symptomatic severe AS and 17 control subjects were included in the study. DTI was performed at the level of the mitral lateral (m(lat)) and septal (m(sep)) annulus. Systolic (Sm), early (Em), and late (Am) diastolic velocities were measured, and E/Em ratio was calculated. NT-proBNP was determined by an electrochemiluminescence immunoassay. RESULTS: Baseline characteristics between patients and control subjects were similar regarding LV ejection fraction and mitral inflow E/A ratio. However, patients with AS had significantly lower DTI values (Sm, Em, Am) compared with control subjects. Moreover, LV filling pressures, expressed by the E/Em ratio, were significantly higher in patients. Correlation analysis showed a relationship between the natural logarithm of NT-proBNP and aortic valve area, Sm(lat), and E/Em((sep)) ratio. Using stepwise multiple linear regression, Sm(lat) was found to be independently related to NT-proBNP. CONCLUSIONS: In patients with severe AS and normal LV ejection fraction, DTI showed LV systolic and diastolic dysfunction compared with control subjects. DTI-derived variables, and especially Sm(lat), were correlated with NT-proBNP levels.
Authors:
Tjebbe W Galema; Sing-Chien Yap; Marcel L Geleijnse; Robert J van Thiel; Jan Lindemans; Folkert J ten Cate; Jolien W Roos-Hesselink; Ad J J C Bogers; Maarten L Simoons
Publication Detail:
Type:  Journal Article     Date:  2007-07-12
Journal Detail:
Title:  Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography     Volume:  21     ISSN:  1097-6795     ISO Abbreviation:  J Am Soc Echocardiogr     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-03-03     Completed Date:  2008-03-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8801388     Medline TA:  J Am Soc Echocardiogr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  257-61     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands. t.w.galema@erasmusmc.nl
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MeSH Terms
Descriptor/Qualifier:
Aged
Aortic Valve Stenosis / blood*,  complications,  ultrasonography*
Echocardiography, Doppler / methods*
Female
Humans
Male
Natriuretic Peptide, Brain / blood*
Peptide Fragments / blood*
Prognosis
Reproducibility of Results
Risk Assessment / methods*
Risk Factors
Sensitivity and Specificity
Ventricular Dysfunction, Left / blood*,  etiology,  ultrasonography*
Chemical
Reg. No./Substance:
0/Peptide Fragments; 0/pro-brain natriuretic peptide (1-76); 114471-18-0/Natriuretic Peptide, Brain

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