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Plasma B-type natriuretic peptide levels in systolic heart failure

importance of left ventricular diastolic function and right ventricular systolic function

Richard W. Troughton, MB, ChB, PhD^*, David L. Prior, MBBS, PhD, Jeremy J. Pereira, MBBS^*, Maureen Martin^*, Annette Fogarty, RDCS, RN^*, Annitta Morehead, RDCS, FASE^*, Timothy G. Yandle, PhD, A. Mark Richards, MD, PhD, DSc, Randall C. Starling, MD, FACC, James B. Young, MD, FACC, James D. Thomas, MD, FACC^* and Allan L. Klein, MD, FRCP(C), FACC, FASE^*,*

^* Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Kaufman Center for Heart Failure, Cleveland Clinic Foundation, Cleveland, Ohio, USA
St. Vincent's Department of Medicine, University of Melbourne, Melbourne, Australia
Christchurch Cardioendocrine Research Group, Christchurch, New Zealand

View larger version (68K): [in a new window]   Figure 1 Diastolic indexes included: 1—transmitral early (E) and late (A) velocities and early deceleration time (DT); 2—pulmonary vein systolic (S), diastolic (D), and atrial reversal (AR) velocities; 3—systolic (Sa) and early (Ea) and late (Aa) diastolic mitral annular velocities measured from tissue Doppler imaging of the septal annulus; 4—the velocity of propagation (Vp) of early filling (from mitral annulus to left ventricular apex) measured from the slope of the first aliasing velocity (11).

View larger version (28K): [in a new window]   Figure 2 Box-plot depiction of plasma B-type natriuretic peptide (BNP) levels according to overall diastolic stage (upper panel; p < 0.001 for trend), right ventricular (RV) function (middle panel; p < 0.001 for trend), and mitral regurgitation (MR) severity (lower panel). The box defines the interquartile range with the median indicated by the crossbar. The error bars indicate the 5th and 95th percentiles.

View larger version (21K): [in a new window]   Figure 3 Scatter plots depicting the relationship of Logn B-type natriuretic peptide (BNP) to early diastolic (Ea) (upper panel) and late diastolic (Aa) (middle panel) mitral annular velocities from tissue Doppler imaging. The lower panel depicts the relationship of Log BNP to the ratio of early transmitral to early mitral annular velocities (E/Ea).

View larger version (21K): [in a new window]   Figure 4 Scatter plots depicting the relationship of Logn B-type natriuretic peptide (BNP) to the combined indexes of filling pressure derived from the ratio of early transmitral velocity to the velocity of propagation of early left ventricular flow (E/Vp) (upper panel), early transmitral deceleration time (DT) (middle panel), left atrial (LA) area (lower panel).