The Clinical Non-invasive Methods Diagnosis Assessment Of The Diastolic Heart Failure With EF>50%

Backgrounds:Diastolic dysfunction of non-specific, not only in the diastolic heart failure(DHF) patients, also found in patients with systolic heart failure(SHF).DHF lack specific identification method, it will consider the performance of HF patients with normal LVEF be defined as heart failure with normal left ventricular ejection fraction ( HFNEF) is more accurate than DHF. Over the past 20 years epidemiologic data indicate that more than 50% HF patients preserved normal left ventricular ejection fraction.The patients of this part have the same degree of danger in prognosis as SHF. And in SHF patients, the heart failure symptoms and prognosis are closely related to the abnormal of diastolic function. Elderly, female, diabetes, obesity, hypertension, coronary heart disease myocardial ischemia, myocardial infarction, are responsible for the cardiac diastolic dysfunction . It is great significance that the early detection and active preventive treatment to diastolic dysfunction for the relief of symptoms and prognosis .Purposes: 1. To explore the early diagnosis target of the DHF with EF>50%; 2. To explore the reliability of early diagnosis for the DHF with EF>50% by plasma NT-proBNP and the E/ E/ of doppler tissues imaging(DTI); 3.To explore the relevance between the plasma NT-proBNP and E/ E/ with left ventricular end-diastolic pressure (LVEDP); 4.To analysis of the best community value of the NT-proBNP and the E/ E/ to the DHF with EF>50%.Metherds:To electe the patients in the internal medicine in heart hospital that plans to carry out the coronary arteriography(CAG)with the way of randomized and double-blind.At the same time the LVEDP and the left ventricular ejection fraction will bemeasured. Then the cases of EF > 50% would be according to LVEDP to divide into two groups: A Group:Eighty LVEDP>16mmHg; B group:Forty LVEDP <16mmHg, (54 male and 26 female, age 57.75±10.15 years. and set up the control group C: Forty-four cases in the healthy people that have basic excluded the cardiovascular disease with the history,physical examination,chest X-ray,electrocardiogram,and conventional echocardio -graphy.The blood samples of the three groups were collected in vitro with EDTA Within 2-3 days.By fluoroimmunoassay methods of bedside quantitative to complete the NT-proBNP concentration.And carry through the mitral flow pattern map and DTI examination to get the data of the E, A, E / A, Vs, Ve (E '), Va, , analysis the relationship between with plasma NT-proBNP and E / E'. Take the LVEDP as the gold standard to build the ROC curve of NT-proBNP and E / E' about the diagnosis of HFNEF.Here EF>50% is the case of HFNEF. Then get the best diagnostic cutoff value and analy the of the results such as the sensitivity, specificity, positive predictive value, negative predictive value and accuracy. All the experimental data state with x±S. Use the statistical software of SPSS13.0 to analyse. To compare multiple sets of data using analysis of variance (ANOVA),compared with a double data using LSD method, inter-related variables for Pearson correlation analysis. Differences in the standard test isP <0.05 (bilateral).Results: 1.The Ve (E /) values of the Three Groups of A,B and C were 6.05±2.75,13.10±5.34,14.12±2.03,it is gradually increased.And among the three groups the difference have the statistically significant; 2. The E / E/ values of the Three Groups of A,B and C were 15±7, 7.19±7.42, 9.25±2.53, gradually decreased, the difference was statistically significant;3. Three groups'NT-proBNP testing values were191.97±13.22,69.24±3.96,39.16±0.85,the differences were statistically significant between A group with B group and C group; 4. By analysis of the relevance we know the E / E / and LVEDP is good correlation (r = 0.552, p <0.001); 5. Take LVEDP as the gold standard to draw the ROC curve about E / E / prediction EF> 50% DHF.When the cutoff value is 15.035,then the diagnosis of EF> 50% DHF sensitivity is 86.3%, specificity is 96.4%, standard error is 0.014,the area under the ROC curve (AUC )is 0.972. the 95% confidence interval (CI) of the area is 0.946 ~ 0.998; 6. According results of the diagnostic when the E / E / take the cutoff value of 15.035 to draw the four tables to calculate the positive predictive value was 90%, negative predictive value was 96.4%, the accuracy was 93.3%;7. By analysis of the relevance we know the NT-proBNP and LVEDP is good correlation (r = 0.415, p <0.001);8. Take LVEDP as the gold standard to draw the ROC curve about NT-proBNP prediction EF>50% DHF.When the cutoff value is 114.42pg/ml,then the diagnosis of EF>50% DHF sensitivity is 83.80%, specificity is 84.1%, standard error is 0.024, the area under the ROC curve (AUC )is 0.909. the 95% confidence interval (CI) of the area is 0.863 ~ 0.955; 9. According the results of the diagnostic when the NT-proBNP take the cutoff value of 114.42pg/ml to draw the four tables to calculate the positive predictive value was86.25%, negative predictive value was86.90%, the accuracy was 86.58%.Conclusion: 1. Early diastolic mitral forword flow velocity to the early diastolic peak velocity of the mitral annulus ratio E / E 'and plasma NT-proBNP and LVEDP there is good correlation In the evaluation of diastolic function; 2. the E / E ' of DTI and plasma NT-proBNP can be used as the evaluation of left ventricular diastolic function and can be a reliable method of prediction LVEDP; 3. the diagnosis of HFNEF positive predictive value that the DTI of E / E '>15 and NT-proBNP>114.42pg/ml is 90% and 86.25%.