The Relationship Between Echocardiogradhic Indices And Nt-Probnp In Patients With Cardiac Dysfunction

Background: Owing to angiotensin converting enzyme (ACE) inhibitors and beta-blockers application to patients with congestive heart failure(CHF), still the disease is fast growing Moreover , patients who survive from AMI are at high risk for CHF. Patients with CHF, the mortality is 50% in five years and is 90% in ten years.The diagnosis of CHF is very difficult,which mainly depends on the electrocardiogram, X-ray and echocardiography. But all of these , lacks sensitivity and specificity , and missdiagnosis for mild degree of CHF is always inccounted. Cardiac neurohormonal markers like B-type natriuretic peptides(BNP) has been identified as a possible tool to identify and treat patients with CHF. In Novermber 2000, American Food and drug administration (FDA) approved BNP for diagnosis of heart failure. However, the price of BNP is expensive, and is not widely available in most hospitals in China, hence, it is only used in scientific researches. Compared with BNP, the amino-terminal fragment of the BNP (NT-proBNP) is advantageous to the clinical application due to its long half-time and wide diagnostic range. However , echocardiograpy has already become a routine check -up to heart disease by use of echo indices to assess the severity of CHF. Moreover, the correlation of these indices especially of the Doppler tissue imaging(DTI) and NT-proBNP are still not widely studied.Objectives:Of this study was to find out the relationships betweenNT-proBNP and LVEF, DTI and the degree of heart function according to N'YHA.Methods:55 patients (range 35-87 years) with CHF and 12 healthy control (range 40-68 years) were selected. The concentration of plasma NT-proBNP was determined by an automated electrochemiluminescence imraunoassay on Roche Elecsys 2010. Left ventricular diameter (LV) , wall thicness , left atrium diameter (LA), ejection fraction (LVEF), early (E) and atrial (A) peak transmitral flow velocities and tissue doppler imaging of mitral annulus were all examined. And E-wave/e , Tei index and a Doppler-derived index of Tei-DTI index all were measured. All patients with heart failure were examined physically and clinically to fit for creteria. For the control history, physical examination and laboratory investigations were done to exclude lung, brain, kidney, thyroid disease and DM diseases.Results:Blood plasma NT-proBNP levels were significantly higher in heart failure patients compared to health control[169(7-18980)pg/ml vs 30(5-239)pg/ml, p<0. 01]. NYHA classification showed positive correlation with NT-proBNP (r=0. 558, p<0. 01), LA (r=0. 509, p<0. 01), LV(r=0. 506, p<0. 01), Tei(r=0. 506, p<0. 01), Tei-DTI(r=0.601,p<0.01), E/e(r=0.635, p<0.01) and negative correlation with LVEF(r=-0.737, p<0.01), Vs (r=-0. 695, p<0. 01), Ve (r=-0. 599, p<0. 01), Va (r=-0. 720, p<0. 01), VTIs (r =-0. 720, p<0. 01), VTIe (r=-0. 652, p<0. 01), VTIa (r=-0. 633, p<0. 01). In heart failure patients , blood plasma NT-proBNP levels showed positive correlation with LA(r=0.503, p<0. 01), LV(r=0. 530, p<0. 01), E/e (r=0. 567, p<0. 01), Tei (r=0. 359, p<0. 01), Tei-DTI (r=0. 441, p<0. 01) and negative correlation with LVEF(r=-0.537, p<0.01),...