To Study The Relationship Between B-type Natriuretic Peptide And Left Ventricular Diastolic Dysfunction

Objective:The purpose of our research is to study the regularity of the variation of the plasma BNP in the patients of asymptomatic diastolic dysfunction group, therefore, we can explore the pathophysiology of left ventricular diastolic dysfunction and search for an evidence to diagnose them earlierly.Methods:1. 100 patients who had been proved to be healthy through health examination in the second hospital of Tianjin medical university were selected as a control group(46men,54 women, average 71±9 years); 2. 108 ADD Patients(57 men, 51 women,average 72±10 years) with the basic cardiovascular diseases and normal EF, but without symptoms of heart failure, fit the diagnostic criteria of diastolic dysfunction by UCG; 3. 95 DHF Patients(59 men, 36 women, average 73±10 years) who has got heart failure with normal EF and fit the diagnostic criteria of diastolic dysfunction by UCG; 4. 103 patients(52 men, 51 women, average 73±8 years) correspond to the diagnostic criteria of the 2014 china heart failure diagnosis and therapy. All Patients were confirmed without following clinical settings: Persistent atrial fibrillation,congenital heart disease, valvular heart disease, more than mild mitral regurgitation,obstructive hypertrophic cardiomyopathy, acute coronary syndrome, Pacing rhythm,severe pulmonary hypertension, severe lung disease, severe renal dysfunction and liver cirrhosis with ascites. All patients were hospitalized the second hospital of Tianjin medical university. The clinical data included sex, age, hypertension, coronary artery disease, myocardiopathy, diabetes, smoking, heart rate, blood lipid, fasting blood glucose, height, weight, surface area, systolic blood pressure, diastolic blood pressure, pulse pressure, we got the left atrium diameter, left atrium volume index,interventricular septum thickness, left ventricular posterior wall thickness, left ventricular end-diastolic diameter,left ventricular end-systolic diameter,left ventricular ejection fraction and left ventricular mass index by ultrasonic cardiogram.1. Comparising the indicators all above among the four groups, and analyze the difference and variation of the plasma BNP in four groups. 2. Making the ROC curve of the plasma BNP to predict the ADD and DHF. 3. Using BNP as a surrogate of left ventricular filling pressure, echocardiographic parameters of diastolic function are investigated in correlation with plasma level of BNP in patients of diastolic dysfunction to determine which index is the best reflection of diastolic function.Results:1. LAD(33.11 ± 4.66 mm vs 29.51 ± 4.47mm),LAVI(30.93 ± 6.44ml/m2 vs 26.95 ±5.98mm/m2),LVEDD(49.21 ± 5.95 mm vs 46.64 ± 3.77mm),LVESD(36.32 ±7.54 mm vs 30.79±5.77mm),LVMI(99.67±32.25g/m2 vs 81.17±21.11g/m2) were different between ADD group and control group(P < 0.05). Cr(79.09 ±19.29mmol/L vs 63.47 ± 14.23mmol/L),TC(4.53 ± 1.14mml/L vs 4.19 ±0.81mmol/L),LAD(34.96±6.67 mm vs 29.51±4.47mm),LAVI(34.86±9.09ml/m2 vs 26.95±5.98ml/m2),LVEDD(50.04±5.76 mm vs 46.64±3.77mm),LVESD(38.33±7.44 vs 30.79±5.77mm),LVMI(117.19±58.62g/m2 vs 81.17±21.11g/m2) were different between DHF group and control group(P<0.05).2. Compared with the control group, the plasma BNP of ADD group was increased(84.9±46.0pg/ml vs 33.3±19.7pg/ml)(P<0.05). Compared with ADD group, the plasma BNPof DHF group was increased(252.1±142.5pg/ml vs 84.9±46.0pg/ml)(p<0.001). Compared with DHF group, the plasma BNP of SHF group was increased(857.4±817.9pg/ml vs 252.1±142.5pg/ml)(P<0.001).3. BNP can identify ADD with AUC of 83.6%, and the cut-off of 60.8pg/ml for BNP showed a sensitivity of 71.3%, specificity of 90%, positive predictive value of 80%,negative predictive value of 89.1%. BNP can identify DHF with AUC of 98.4%,and the cut-off of 98.6pg/ml for BNP showed a sensitivity of 95.8%, specificity of94%, positive predictive value of 97.5%, negative predictive value of 90.9%. To distinguish ADD from DHF, BNP showed AUC of 87.8%, and the cut-off 163.9pg/ml for BNP showed a sensitivity of 68.4%, with a specificity of 97.2%, positive predictive value of 86.1%, negative predictive value of 91.4%.4.The plasma BNP of asymptomatic diastolic dysfunction group was positive correlation with age(r=0.252,p=0.009), PP(r=0.299,p=0.002), left atrium diameter( r=0.330,p=0.000), left atrium volume index(r=0.447,p=0.000), left ventricular posterior wall thickness(r=0.220,p=0.026). The plasma BNP of diastolic heart failure group was positive correlation with left atrium diameter(r=0.331,p=0.001)、left atrium volume index(r=0.346,p=0.001).Conclusion:1. Left atrium volume index, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, and left ventricular mass indexlevel of asymptomatic diastolic dysfunction groups were higher than control group. Cr, total cholesterol,left atrium diameter, left atrium volume index, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, and left ventricular mass indexlevel of diastolic heart failure groups were higher than control group.2. The plasma BNP of the patients in asymptomatic diastolic dysfunction group and diastolic heart failure group was elevated, and the plasma concentration of BNP was increased furtherly by the severity of the ventricular diastolic dysfunction.Therefore, the plasma BNP can be regarded as a diagnostic criteria of left ventricular diastolic dysfunction, and the elevated degree of the plasma BNP can suggested the severity of the disease.3. BNP had a higher specificity and negative predictive value in predicting the occur of ADD. BNP had a higher sensitivity and specificity in predicting the occur of DHF.4. It shows that the plasma BNP is elevated with the increasing age、pulse pressure、left atrium diameter 、 left atrium volume index and left ventricular posterior wall thickness in asymptomatic diastolic dysfunction group. In diastolic heart failure group, the plasma BNP is elevated with the increasing left atrium diameter 、 left atrium volume index.