Table 4.28Methodological characteristics of studies considering Natriuretic peptides vs. Echo measures

Aim of trialPopulationType of testComparisonDiagnosis of diastolic dysfunction
Islamoglu 2008

N=30
To look at the diagnostic performance of NT- proBNP in the assessment of post- operative left ventricular diastolic dysfunction in patients undergoing CABG, by comparing NT-proBNP with echo results (Ea + E/Ea ratio).Patients who were undergoing coronary artery bypass graft (CABG)N-Terminal Pro-Brain Natriuretic peptide
NT- proBNP
Echocardiogram
E/Ea ratio ≤15 diastolic function was normal; E/Ea >15 diastolic function was defined as abnormal.
When the echo measures:
-

Ea <8 cm/s

-

E/Ea >15

the diastolic function was defined as abnormal.
Hettwer 2007

N=140
To look at the diagnostic value of tissue Doppler imaging, flow propagation velocity and NT-proBNP in comparison with standard echo parameters in diastolic dysfunction.Patients admitted to the cardiology department for:
  1. dyspnoea of cardiac origin
  2. clinical signs of heart failure with normal left ventricular systolic function
  3. longstanding arterial hypertension
NT- proBNPEchocardiogram
Myocardial relaxation velocity
Flow propagation velocity of transmitral inflow
In agreement with the guidelines of the ‘European Study on Diastolic Heart Failure’- split into 3 patterns according to different echo measures (E/A ratio, DT, IVRT, S/D ratio):
  1. impaired relaxation pattern.
  2. pseudomormal pattern
  3. restrictive pattern
(- figures provided)
Tschope 2005

N=118
To look at the accuracy of NT-proBNP at detecting isolated diastolic dysfunction in comparison to left and right heart catherization, transmitral Doppler echo, pulmonary venous Doppler and tissue Doppler imaging in patients with suspected chronic heart failure despite preserved LV systolic function.Patients with preserved LV function and normal LV dimensions as determined by echocardiography and ventriculography.NT- proBNPEchocardiography
Diastolic dysfunction diagnosed by abnormal values Tau, IVRT, DT, and/or by the E/A ratio
In agreement with the guidelines of the ‘European Study on Diastolic Heart Failure’- the diagnosis of diastolic dysfunction was defined after the evidence of abnormal LV relaxation, filling, and/or diastolic distensibility in the presence of clinical signs of CHF, with demonstrable normal or only mildly impaired systolic function (EF>50%).
(- figures provided)

E: early phase wave representing the early phase filling of the ventricle as seen on Doppler flow pattern through the mitral and tricuspid valves on echocardiography

A: late phase (atrial) wave representing the late phase filling of the ventricle as seen on Doppler flow pattern through the mitral and tricuspid valves on echocardiography

Ea: early diastolic phase wave on tissue Doppler imaging of the mitral valve annulus on echocardiography

DT: Deceleration time of the E wave

S/D ratio: The ratio between the systolic and the diastolic waves on the trans-pulmonary venous flow pattern on Doppler echocardiography

Tau: The time constant of relaxation (one of the measures of the diastolic function of the ventricle).

From: 4, Diagnosing heart failure

Cover of Chronic Heart Failure
Chronic Heart Failure: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care: Partial Update [Internet].
NICE Clinical Guidelines, No. 108.
National Clinical Guideline Centre (UK).
Copyright © 2010, National Clinical Guideline Centre.

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