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Clin Res Cardiol. 2011 Oct;100(10):887-96. doi: 10.1007/s00392-011-0319-y. Epub 2011 May 3.

Diagnostic accuracy of NT-proBNP ratio (BNP-R) for early diagnosis of tachycardia-mediated cardiomyopathy: a pilot study.

Author information

1
Department of Internal Medicine III, University of Cologne, Germany.

Abstract

BACKGROUND:

When heart failure and tachycardia occur simultaneously, a useful diagnostic tool for early discrimination of patients with benign tachycardia-mediated cardiomyopathy (TMC) versus major structural heart disease (MSHD) is not available. Such a tool is required to prevent unnecessary and wearing diagnostics in patients with reversible TMC. Moreover, it could lead to early additional diagnostics and therapeutic approaches in patients with MSHD.

METHODS:

A total of 387 consecutive patients with supraventricular arrhythmia underwent assessment at a single center. Of these patients, 40 fulfilled the inclusion criteria with a resting heart rate ≥100 bpm and an impaired left ventricular ejection fraction <40%. In all patients, successful electrical cardioversion was performed. At baseline, day 1 and weekly for 4 weeks, levels of NT-proBNP and echocardiographic parameters were evaluated. An NT-proBNP ratio (BNP-R) was calculated as a quotient of baseline NT-proBNP/follow-up NT-proBNP. After 4 weeks, cardiac catheterization was performed to identify patients with a final diagnosis of TMC versus MSHD.

RESULTS:

Initial NT-proBNP concentrations were elevated and consecutively decreased after cardioversion in all patients. Multivariate regression and ROC analysis revealed that BNP-R discriminated between patients with TMC versus MSHD independent and superior to all other variables. The area under the ROC curve for BNP-R to detect TMC was 0.90 (95% CI 0.79-1.00; p < 0.001) after 1 week and 0.995 (95% CI 0.99-1.00; p < 0.0001) after 4 weeks. One week after cardioversion already, a BNP-R cutoff ≥2.3 was useful for TMC diagnosis indicated by an accuracy of 90%, sensitivity of 84% and specificity of 95%.

CONCLUSION:

BNP-R was found to be highly accurate for the early diagnosis of TMC.

PMID:
21538234
DOI:
10.1007/s00392-011-0319-y
[Indexed for MEDLINE]

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