Heart Failure: Discrepancy Between NYHA Functional Classification, Serum NT-pro Brain Natriuretic Peptide and Ejection Fraction
Abstract
This study aimed to look for the discrepancy between the laboratory investigation (determination of serum NT-proBNP), electrophysiological assessment (echocardiogram and Doppler study) and clinical assessment of known cases of congestive heart failure.This study conducted in the college teaching hospital from January to October 2011. This study is a cross-sectional in a cohort of patients with heart failure. Known cases of congestive heart failure and healthy subjects served as control group were enrolled in this study. Patients were assessed clinically according to the New York Heart Association (NYHA) functional classification, echocardiography by ejection fraction and laboratory by determination of NT-proBNP).Student's "t" test (one paired, two tailed) and simple correlation test were used in data analysis. The results of 169 patients enrolled in this study showed that serum levels of NT-proBNP did not match the NYHA functional classification of heart failure. Serum NT-proBNP was significantly inversed-correlated (r = -0.339, p < 0.001) with the ejection fraction and inconsistently related to the E/A ratio assessed by Doppler study. It concludes that serum NT-proBNP level is well correlated with ejection fraction and not well matched the functional disabilities of longstanding heart failure.
Keywords
References
- Richards AM, Nicholls MG, Yandle TG, et al. Plasma N-terminal pro-brain natriuretic peptide and adreno- medullin: new neurohormonal predictors of left ventricu- lar function and prognosis after myocardial infarction. Circulation 1998;97:1921-9
- Anand IS, Fisher LD, Chiang Y-T, et al. Changes in brain natriuretic peptide and norepinephrine over time and mortality and morbidity in the Valsartan Heart Failure Trial (Val-HeFT). Circulation 2003;10:1278-83
- Gopal DJ, Iqbal MN, Maisel A. Updating the role of natri- uretic peptide levels in cardiovascular disease. Postgrad Med 2011;123:102-13
- Linssen GC, Rienstra M, Jaarsma T, et al. Clinical and prognostic effects of atrial fibrillation in heart failure patients with reduced and preserved left ventricular ejection fraction. Eur J Heart Fail 2011;13:1111-20
- Masugata H, Senda S, Murao K, et al. Association between echocardiographic parameters and brain natriuretic pep- tide levels in treated hypertensive patients. Clin Exp Hypertens 2011;33:187-91
- Gariani K, Delabays A, Perneger TV, Agoritsas T. Use of brain natriuretic peptide to detect previously unknown left ventricular dysfunction in patients with acute exac- erbation of chronic obstructive pulmonary disease. Swiss Med Wkly 2011;141:w13298.
- Prastaro M, Paolillo S, Savarese G, et al. N-terminal pro- b-type natriuretic peptide and left atrial function in pa- tients with congestive heart failure and severely reduced ejection fraction. Eur J Echocardiogr 2011;12:506-13
- Krzych LJ, Szurlej D, Kołodziej T, et al. Diagnostic accu- racy of pre-operative NT-proBNP level in predicting short- term outcomes in coronary surgery: a pilot study. Kardiol Pol 2011;69:1121-7
- Bao Y, Shang X, Zhou L, Hu R, Li Y, Ding W. Relationship between N-terminal pro-B-type natriuretic peptide levels and metabolic syndrome. Arch Med Sci 2011;7:247-256
- Kirkwood BR. Calculation of required sample size. In: Kirkwood BR, editor. Essentials of Medical Statistics, 1st edn. Oxford:Blackwell Scientific Publications; 1988.p.191-200
- McKie PM, Cataliotti A, Sangaralingham S, et al. Predictive utility of atrial, N-terminal pro-atrial, and N-terminal pro-B-type natriuretic peptides for mortality and cardiovascular events in the general community: a 9-year follow-up study. Mayo Clin Proc 2011; 86:1154-60
- Li WY, Chiu FC, Chien YF, Lin JW, Hwang JJ. Association of amino-terminal pro-brain natriuretic peptide with meta- bolic syndrome. Intern Med 2011;50:1143-7
- Sezen Y, Baş M, Demirbag R, Yildiz A, Celik H, Aksoy S. N-terminal pro-brain natriuretic peptide in cases with metabolic syndrome and its relationship with components of metabolic syndrome and left ventricular mass index. Clin Biochem 2009;42:1500-3
- Januzzi JL Jr, Chen-Tournoux AA, Moe G. Amino-terminal pro-B-type natriuretic peptide testing for the diagnosis or exclusion of heart failure in patients with acute symp- toms. Am J Cardiol 2008;101:29-38
- Hejmdal A, Boesgaard S, Lindholm MG, Goetze JP. B-type natriuretic peptide and its molecular precursor in myo- cardial infarction complicated by cardiogenic shock. J Card Fail 2007;13:184-8
- Al Bannay RA, Husain AA. Role of tissue Doppler imaging in assessing left ventricular diastolic dysfunction severity. Does it hold the same ability? Saudi Med J 2012;33:34-8
- Loncar G, von Haehling S, Tahirovic E, et al. Effect of beta blockade on natriuretic peptides and copeptin in elderly patients with heart failure and preserved or reduced ejection fraction: Results from the CIBIS-ELD trial. Clin Biochem 2012;45:117-22
- Waliszek M, Waliszek-Iwanicka A, Grycewicz T, et al. Prognostic value of plasma N-terminal pro-B-type na- triuretic peptide concentration in patients with normal and impaired left ventricular systolic function undergo- ing surgery for abdominal aortic aneurysm. Arch Med Sci 2011;7:642-7
Heart Failure: Discrepancy Between NYHA Functional Classification, Serum NT-pro Brain Natriuretic Peptide and Ejection Fraction
Abstract
Bu çalışma konjestif kalp yetmezliği bilinen olgularda laboratuar inceleme (serum NT-pro BNP değerlendirmesi), elektrofizyolojik değerlendirme (ekokardiyografi ve Doppler çalışması) ve klinik değerlendirme arasındaki tutarsızlığı araştırmayı amaçlamıştır. Bu çalışma Ocak-Ekim 2011 tarihleri arasında üniversite araştırma hastanesinde yapılmıştır. Bu, kalp yetmezliği olan hastalardan oluşan bir kohortta kesitsel bir çalışmadır. Konjestif kalp yetmezliği bilinen vakalar ve sağlıklı bireyler bu çalışmaya kontrol grubu olarak katılmışlardır. Hastalar, klinik olarak New York Kalp birliğinin (NYHA) fonksiyonel sınıflaması, ekokardiyografik olarak ejeksiyon fraksiyonu ve laboratuar inceleme olarak NT-pro BNP değerine göre değerlendirilmişlerdir. Veri analizi Student’s t testi (bir çift, iki uçlu) ve basit korelasyon testi kullanılarak yapılmıştır. Çalışmaya alınan 169 hastanın sonuçları göstermiştir ki serum NT- pro BNP düzeyleri kalp yetmezliğinin NYHA fonksiyonel sınıflaması ile uyumlu değildir. Serum NT-pro BNP düzeyleri anlamlı şekilde ejeksiyon fraksiyonu ile ters orantılıdır (r = -0.339, p < 0.001) ve Doppler çalışması ile değerlendirilen E/A oranı ile tutarsız şekilde ilişkilidir. Sonuç olarak serum NT-pro BNP düzeyleri ejeksiyon fraksiyonu ile iyi koreledir ve uzun süren kalp yetmezliğinin fonksiyonel kısıtlamaları ile iyi uyum göstermemektedir
References
- Richards AM, Nicholls MG, Yandle TG, et al. Plasma N-terminal pro-brain natriuretic peptide and adreno- medullin: new neurohormonal predictors of left ventricu- lar function and prognosis after myocardial infarction. Circulation 1998;97:1921-9
- Anand IS, Fisher LD, Chiang Y-T, et al. Changes in brain natriuretic peptide and norepinephrine over time and mortality and morbidity in the Valsartan Heart Failure Trial (Val-HeFT). Circulation 2003;10:1278-83
- Gopal DJ, Iqbal MN, Maisel A. Updating the role of natri- uretic peptide levels in cardiovascular disease. Postgrad Med 2011;123:102-13
- Linssen GC, Rienstra M, Jaarsma T, et al. Clinical and prognostic effects of atrial fibrillation in heart failure patients with reduced and preserved left ventricular ejection fraction. Eur J Heart Fail 2011;13:1111-20
- Masugata H, Senda S, Murao K, et al. Association between echocardiographic parameters and brain natriuretic pep- tide levels in treated hypertensive patients. Clin Exp Hypertens 2011;33:187-91
- Gariani K, Delabays A, Perneger TV, Agoritsas T. Use of brain natriuretic peptide to detect previously unknown left ventricular dysfunction in patients with acute exac- erbation of chronic obstructive pulmonary disease. Swiss Med Wkly 2011;141:w13298.
- Prastaro M, Paolillo S, Savarese G, et al. N-terminal pro- b-type natriuretic peptide and left atrial function in pa- tients with congestive heart failure and severely reduced ejection fraction. Eur J Echocardiogr 2011;12:506-13
- Krzych LJ, Szurlej D, Kołodziej T, et al. Diagnostic accu- racy of pre-operative NT-proBNP level in predicting short- term outcomes in coronary surgery: a pilot study. Kardiol Pol 2011;69:1121-7
- Bao Y, Shang X, Zhou L, Hu R, Li Y, Ding W. Relationship between N-terminal pro-B-type natriuretic peptide levels and metabolic syndrome. Arch Med Sci 2011;7:247-256
- Kirkwood BR. Calculation of required sample size. In: Kirkwood BR, editor. Essentials of Medical Statistics, 1st edn. Oxford:Blackwell Scientific Publications; 1988.p.191-200
- McKie PM, Cataliotti A, Sangaralingham S, et al. Predictive utility of atrial, N-terminal pro-atrial, and N-terminal pro-B-type natriuretic peptides for mortality and cardiovascular events in the general community: a 9-year follow-up study. Mayo Clin Proc 2011; 86:1154-60
- Li WY, Chiu FC, Chien YF, Lin JW, Hwang JJ. Association of amino-terminal pro-brain natriuretic peptide with meta- bolic syndrome. Intern Med 2011;50:1143-7
- Sezen Y, Baş M, Demirbag R, Yildiz A, Celik H, Aksoy S. N-terminal pro-brain natriuretic peptide in cases with metabolic syndrome and its relationship with components of metabolic syndrome and left ventricular mass index. Clin Biochem 2009;42:1500-3
- Januzzi JL Jr, Chen-Tournoux AA, Moe G. Amino-terminal pro-B-type natriuretic peptide testing for the diagnosis or exclusion of heart failure in patients with acute symp- toms. Am J Cardiol 2008;101:29-38
- Hejmdal A, Boesgaard S, Lindholm MG, Goetze JP. B-type natriuretic peptide and its molecular precursor in myo- cardial infarction complicated by cardiogenic shock. J Card Fail 2007;13:184-8
- Al Bannay RA, Husain AA. Role of tissue Doppler imaging in assessing left ventricular diastolic dysfunction severity. Does it hold the same ability? Saudi Med J 2012;33:34-8
- Loncar G, von Haehling S, Tahirovic E, et al. Effect of beta blockade on natriuretic peptides and copeptin in elderly patients with heart failure and preserved or reduced ejection fraction: Results from the CIBIS-ELD trial. Clin Biochem 2012;45:117-22
- Waliszek M, Waliszek-Iwanicka A, Grycewicz T, et al. Prognostic value of plasma N-terminal pro-B-type na- triuretic peptide concentration in patients with normal and impaired left ventricular systolic function undergo- ing surgery for abdominal aortic aneurysm. Arch Med Sci 2011;7:642-7
Details
| Primary Language | English |
|---|---|
| Journal Section | Original Articles |
| Authors | |
| Publication Date | March 1, 2013 |
| Published in Issue | Year 2013 Volume: 10 Issue: 1 |