Predictive value of B-type natriuretic peptides in detecting latent left ventricular diastolic dysfunction in β-thalassemia major

Autor: Kleanthi Dima, John Parissis, Dimitrios Th. Kremastinos, Eftihia S. Hamodraka, Alan S. Maisel, Dimitrios Tsiapras
Rok vydání: 2010
Předmět:
Male
medicine.medical_specialty
Adolescent
Heart disease
medicine.drug_class
Diastole
Doppler echocardiography
Risk Assessment
Severity of Illness Index
Asymptomatic
Statistics
Nonparametric
Ventricular Dysfunction
Left
Young Adult
Tissue Doppler echocardiography
Predictive Value of Tests
Reference Values
Internal medicine
Natriuretic Peptide
Brain
medicine
Natriuretic peptide
Humans
cardiovascular diseases
Probability
Observer Variation
Analysis of Variance
Heart Failure
Diastolic
Ejection fraction
E/A ratio
medicine.diagnostic_test
business.industry
beta-Thalassemia
Prognosis
medicine.disease
Echocardiography
Doppler
Peptide Fragments
ROC Curve
Case-Control Studies
Linear Models
Cardiology
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
business
Biomarkers
hormones
hormone substitutes
and hormone antagonists
Zdroj: American Heart Journal. 159:68-74
ISSN: 0002-8703
DOI: 10.1016/j.ahj.2009.10.025
Popis: Beta-thalassemia major is a unique disease characterized by early diastolic dysfunction, related exclusively to iron myocardial deposition. N-terminal-proBNP(amino-terminal) (NT-proBNP) and B-type natriuretic peptide (BNP) are sensitive biomarkers for the detection of asymptomatic left ventricular (LV) dysfunction, and they have important diagnostic and prognostic implications. Using beta-thalassemia as a model disease with isolated diastolic dysfunction, we sought to investigate the predictive value of NT-proBNP and BNP levels in comparison with the conventional and new Doppler echocardiography indexes in detecting this disorder.Seventy beta-thalassemia major patients (mean age 27.2 +/- 12.5 years) with normal LV systolic function (mean LV ejection fraction = 59% +/- 6.8%), and 50 healthy age-matched adults (control group: mean age 25.5 +/- 10.1 years, mean LV ejection fraction = 60% +/- 4.5%) were included. All subjects were studied thoroughly by tissue Doppler echocardiography and blood samples were taken for plasma NT-proBNP and BNP measurements at the same time. To examine LV diastolic function, patients were divided in 3 groups according to the E mitral/E mitral annulus ratio (E/E'): group A, patients without diastolic dysfunction: E/E' ratio8; group B, patients with suspected diastolic dysfunction: E/E' ratio 8 to 15; group C, patients with documented diastolic dysfunction: E/E' ratio,15.NT-proBNP and BNP levels were higher in thalassemic patients compared with the control group (NT-proBNP levels: 80 +/- 19 vs 21 +/- 4 pg/mL, P.001; BNP levels: 34 +/- 6 vs 9 +/- 3 pg/mL, P.001). NT-proBNP levels showed a statistically significant increase in group C in comparison to groups A and B, which was also detected between groups A and B (A vs B: P.05). BNP levels were also significantly increased in group C in comparison to the other 2 groups, but there was no statistically significant difference between groups A and B. Using receiver operating characteristic analysis, NT-proBNP at a cut point of 49.2 pg/mL was highly accurate (area under curve: 0.97, P.001) in ruling out diastolic dysfunction (E/E'8) with a sensitivity of 93.7% and a specificity of 89.6%.BNP and NT-proBNP levels are significantly increased in documented left ventricular diastolic dysfunction, while NT-proBNP seems to have better predictive value in detecting latent left ventricular diastolic dysfunction in beta-thalassemia major.
Databáze: OpenAIRE
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