| Objective: diastolic dysfunction refers to the pathophysiologic state resulting from ventricular relaxation dysfunction or filling dysfunction, in which the ventricular volume decrease or the ventricular pressure increase compensatorily. Nowadays, The studies on diastolic dysfunction mainly focus on the pathophysiolgy of diastolic heart failure (DHF). However, the investigations show that there are lots of asymptomatic diastolic dysfunction patients in the community, who has normal ejection fraction, and were called "asymptomatic diastolic dysfunction, ADD". ADD largely involve the elderly who suffered from the risk factors, such as hypertension, coronary artery disease, diabetes, etc. those patients are not treated well because of the silence of the symptoms. The mortality, clinic features, effective treatment and the relation between ADD and DHF are rarely reported. The fact that brain natriuretic peptide (BNP) and N terminal pro brain natriuretic peptide have been proven to be upregulated significantly in systolic heart failue, but few report the change of BNPs in ADD. Traditional and novel method of UCG were used to evaluate the state of cardiac function in ADD, and BNP and NT-proBNP were tested, elderly DHF patients and age-matched senile normal control were compared. The systolic and diastolic dysfunction and diagnostic value of BNP and NT-proBNP were discussed. Methods: UCG was performed in the following groups of patients: 1. 166 elderly ADD patients older than 60, with the basic cardiovascular diseases and normal EF, but without symptoms of heart failure, fit the diagnostic criteria of diastolic dysfunction by UCG;2. 153 elderly DHF patients who has got heart failure with normal EF and fit the criteria for the diagnosis of diastolic dysfunction. 77 senile healthy volunteers were selected as normal control. Left ventricular (LV) thickness and dimension were derived from M-mode echocardiography, LV volume and LVEF were calculated with Simpson's biplane method. Pulsed wave Dopplerimaging was used to obtain the trans-mitral flow velocities: E wave and A wave. Decelerating time (DT) and A duration (AD) were measured. The Doppler sample volume were placed lcm into the right upper pulmonary vein to get the S wave (PVs), D wave (PVd) and a reversal wave (PVa). PVa duration (PVaD) was measured to calculate the value of PVaD minus AD. The early diastolic flow propagation velocity in left ventricle (Vp) was measured using color M-mode echocardiography. Tissue Doppler imaging (TDI) were performed and the mitral septal, lateral, anterior and inferior wall, and the peak regional myocardial sustained systolic (Sm) and early diastolic (Em) velocities were measured. Blood samples of these patients were obtained within 12 hours after or before the echocardiography exam. BNP were tested using sandwich immunoassay and NT-proBNP were tested by electrochemiluminescence immunoassay. Data were analyzed with a statistic software program (SPSS version 12.0 for windows).Results: 1 Compared with the controls, The elder ADD and DHF patents present significant ventricular dilatation and overt atrial enlargement with evident hypertrophy. 2. E/Em, E/Vp increase and Em, Vp decrease significantly in ADD patients, significant difference between any two groups were found.(p<0.001). 3. Sm in 4 sites of mitral annulus in elderADD and DHF decrease significantly compared with controls, so dose the mean Sm. (p<0.001). 4. the level of plasma BNP and NT-proBNP increased in ADD, with the relation DHF>ADD>Normal. 5. regardless of in or between groups of ADD and DHF, the elevation of BNP and NT-proBNP level was related to Sm and the severity of diastolic dysfunction. 6 NT-proBNP can identify DD with AUC of 0.846 respectively, and the cut-off of 95pg/ml 136.75pg/ml for NT-proBNP showed a sensitivity of 79% and 91% o To distinguish DD from DHF, BNP and NT-proBNP showed AUC of 0.817 and 0.869 respectively, and the cut-off of 106.87pg/ml for BNP and 243.35pg/ml for NT-proBNP showed a sensitivity of 82% and 73% ,with a specificity of 73% and 83% respectively.Conclusion: 1 .the change of diastolic and systolic function in elderly ADD patients have result in the enlargement of left atria and ventricle, a much lesser extent than DHF. 2. there are not only diastolic dysfunction but also systolic funtion in ADD andDHF ,systolic dysfunction and diastolic dysfunction may influenced the progression of elderly ADD and DHF together.3 the BNP and NT-proBNP levels increased significantly in ADD, but lower than DHF .4. BNP and NT-proBNP were related to the systolic dysfunction and diastolic dysfunction significantly, and diastolic dysfunction better .5 NT-proBNP can be used to diagnose DD, but BNP not, Both of them can identify ADD from DHF,and the diagnostic value of NT-proBNP is higher.
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