The Diagnostic Value Of Plasma N-Terminal Pro-brain Natriuretic Neptide In The Heart Failure With Preserved Ejection Fraction

Objective: Through the comparative study of NT-pro-BNP, invasive hemodynamic index and echocardiogram, to explore the role of NT-pro-BNP in the diagnosis of HF-PEF.Methods: this study enrolled 167 patients hospitalized in the Affiliated Hospital of Qingdao University from June 2012 to June 2014, of which 57 were confirmed with HF-PEF, 59 were HF-REF and 51 with normal left ventricular diastolic function as control group.Assay the NT-pro-BNP.in serum with electrochemiluminescence.Using cardiac catheterization to detect the maximum rate of left ventricular diastolic pressure dropping(dp / dtmin) and left ventricular end-diastolic pressure(LVEDP).With echocardiogram measure the cardiac septal thickness(IVST), left ventricular posterior wall thickness(LVPWT), left ventricular end-diastolic diameter(LVEDd), left ventricular end systolic diameter(LVESd), left atrial diameter(LAD), left ventricular ejection fraction( LVEF);Doppler flow spectrum measure mitral early diastolic filling peak velocity(E value), peak late diastolic transmitral filling velocity(A value), E / A ratio and E wave deceleration time(DT). And tissue Doppler measure the early diastolic maximum velocity e of myocardial at mitral septal side and the maximum late diastolic myocardial velocity a to calculate e / a ratio; measure diastolic pulmonary venous flow velocity D, systolic pulmonary venous flow velocity S to calculate S / D ratio, measure echo peak flow(Ar) due to the left atrial contraction in late diastolic; measure left ventricular mass index(LVMI). Comparison the result of NT-pro-BNP, echocardiography and left cardiac catheterization of patients in different group.Application of SPSS 17.0 for statistical analysis. Take p <0.05 as considered statistically significant.Results: The difference of LVEDP values and dp / dtmin value were statistically significant between each group, with p <0.01 between HF-PEF group and HF-REF group, p <0.001 both in HF-PEF group and HF-REF group compared with control groups.With the increase of severity in HF-PEF, the concentrations of NT-pro-BNP in plasma were significantly increased(R = 0.72, p <0.001), NT-pro-BNP levels increased accompanied with higher NYHA classification(R = 0.54, p <0.001).Linear regression analysis showed that NT-pro-BNP concentration had strong correlation with LVEDP(R = 0.48, p <0.001), had. moderately correlation with e(R =- 0.36, p<0.001), e / a(R =- 0.31, p <0.001),and no correlation with dp / dtmin, LVEDD, LVMI,DT, S, D, S / D, Ar, E, A and E / A. Taking NT-pro-BNP threshold at 240pg/ml, the sensitivity of diagnosis HF-PEF was 77%, specificity was 96%, negative predictive value was 94%, positive predictive value was 85%. With the highest negative predictive value of all the non-invasive examination, the multiple linear regression analysis showed that, NT-pro-BNP is an independent predictor of HF-PEF [OR = 1.3,(1.0-1.5,95% CI)].conclusion: NT-pro-BNP can be used as indicators of HF-PEF, and its concentrations is well correlated with degree of NYHA class.