N-terminal pro-B-type natriuretic peptide and diastolic function measurements by adenosine stress echocardiography in prediction of coronary stenosis in patients

( views:71, downloads:0 )
Author:
ZHENG Ping(Department of Echocardiography,Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China)
SUN Xin(Department of Echocardiography,Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China)
ZHANG Ling(Department of Nuclear Medicine,Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China)
WANG Hao(Department of Echocardiography,Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China)
TIAN Yue-qin(Department of Nuclear Medicine,Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China)
GUO Yuan-lin(Center of Coronary Heart Diseases,Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China)
HE Zuo-xiang(Department of Nuclear Medicine,Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China)
LU Ye(Department of Echocardiography,Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China)
ZHENG Xin(Center of Coronary Heart Diseases,Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China)
MA Wen-jun(Center of Hypertension,Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China)
XU Nan(Department of Echocardiography,Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China)
Journal Title:
CHINESE MEDICAL JOURNAL
Issue:
Volume 124, Issue 14, 2011
DOI:
10.3760/cma.j.issn.0366-6999.2011.14.002
Key Word:
adenosine;echocardiography;diastole;coronary stenosis;N-terminal pro-B-type natriuretic peptide

Abstract: Background Stress echocardiography is mainly used in detection of coronary artery disease (CAD) and to assess risk.This study aimed to use adenosine stress echocardiography (ASE) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) to noninvasively assess coronary stenosis in patients with chest pain syndromes or anginal equivalent.Methods NT-proBNP was measured after overnight fast in fifty patients, 42 males and 8 females, who were (57+11)years old. They then underwent echocardiography before and during adenosine administration. Left ventricular (LV)diastolic function analyzed included mitral annular early (E') and late velocity (A') both at the mitral septal and lateral level and the mitral inflow to annulus ratio (E/E'). Coronary angiography was performed the following day after which patients were assigned to three groups: normal results (16 patients), stenosis 50%-69%(17 patients) and stenosis≥70% (17 patients).Results NT-proBNP levels in the groups of stenosis 50%-69% and≥ 70% were significantly higher than that in the group with normal results (P=0.014 and P=0.040). During adenosine stress, the E/E' in the group of stenosis≥70% was higher than in the group of normal results (P=0.024). E'lateral/A'lateral in the group of stenosis 50%-69% and E'septal/A'septal and E'lateral/A'lateral in the group of stenosis≥70% were also decreased during stress compared with baseline (P=0.003,P=0.001, P=0.022). The variation of E'septal/A'septal before and during adenosine stress (△E'septal/A'septal) between the groups of normal results and stenosis ≥70% were significantly different (P=0.001). By receiver operating characteristic (ROC), the specificity of △E'septal/A'septal ≥0.037 predicting coronary stenosis <70% was 94%. The sensitivity and specificity of NT-proBNP≥544.6 fmol/ml in predicting coronary stenosis ≥70% were 93% and 75%, respectively.NT-proBNP inversely correlated with E'lateral/A'lateral (r=-0.390, P=0.014) and positively correlated with E/E'lateral(r=0.550,P=0.001).Conclusions Adenosine might induce diastolic dysfunction in patients with coronary stenosis more than 70% and NT-proBNP could reflect LV diastolic function to a certain extent. We support the prediction that most patients having chest pain syndromes or anginal equivalent with NT-proBNP<544.6 fmol/ml and in ASE AE'septal/A'septal≥0.037 might be spared coronary angiography.

  • [1]Douglas PS,Khandheria B,Stainback RF Weissman NJ,Peterson ED,Hendel RC,et al.ACCF/ASE/ACEP/AHA/ASNC/SCAI/SCCT/SCMR 2008 appropriateness criteria for stress echocardiography:a report of the American College of Cardiology Foundation Appropriateness Criteria Task Force,American Society of Echocardiography,American College of Emergency Physicians,American Heart Association,American Society of Nuclear Cardiology,Society for Cardiovascular Angiography and Interventions,Society of Cardiovascular Computed Tomography,and Society for Cardiovascular Magnetic Resonance:endorsed by the Heart Rhythm Society and the Society of Critical Care Medicine.Circulation 2008; 117:1478-1497.
  • [2]Chaudhry FA.Adenosine stress echocardiography.Am J Cardiol 1997; 79:25-29.
  • [3]Xing YQ,Hou BW,Zhang Y,Liu XQ,Gao HQ.Comparison of adenosine stress and dobutamine stress by real-time myocardial contrast echocardiography in detecting myocardium ischemia in dogs.Chin Med J 2009; 122:2002-2007.
  • [4]Schinckel AF,Bax JJ,Geleijnse ML,Boersma E,Elhendy A,Roelandt JR,et al.Noninvasive evaluation of ischemic heart disease:myocardial perfusion imaging or stress echocardiography? Eur Heart J 2003; 24:789-800.
  • [5]Gudmundsson P,Shahgaldi K,Winter R,Dencker M,Kitlinski M,Thorsson O,et al.Parametric quantification of myocardial ischaemia using real-time perfusion adenosine stress echocardiography images,with SPECT as reference method.Clin Physiol Funct Imaging 2010; 30:30-42.
  • [6]Abdelmoneim SS,Bernier M,Dhoble A,Moir S,Hagen ME,Ness SA,et al.Diagnostic accuracy of contrast echocardiography during adenosine stress for detection of abnormal myocardial perfusion:a prospective comparison with technetium-99m sestamibi single-photon emission computed tomography.Heart Vessels 2010; 25:121-130.
  • [7]Winter R,Gudmundsson P,Willenheimer R.Real-time perfusion adenosine stress echocardiography in the coronary care unit:a feasible bedside tool for predicting coronary stenosis in patients with acute coronary syndrome.Eur J Echocardiogr 2005; 6:31-40.
  • [8]Senior R,Becher H,Monaghan M,Agati L,Zamorano J,Vanoverschelde JL,et al.Contrast echocardiography:evidence-based recommendations by European Association of Echocardiography.Eur J Echocardiogr 2009; 10:194-212.
  • [9]Saha SK,Brodin LA,Lind B,Svedenhag J,Str(aa)t E,Gunnes S.Myocardial velocities measured during adenosine,dobutamine and supine bicycle exercise:a tissue Doppler study in healthy volunteers.Clin Physiol Funct Imaging 2004;24:281-288.
  • [10]Espiner EA,Richards AM,Yandle TG,Nicbolls MG.Natriuretic hormones.Endocrinol Metab Clin North Am 1995;24:481-509.
  • [11]Hunt PJ,Richards AM,Nicholls MG,Yandle TG,Doughty RN,Espiner EA.Immunoreactive amino terminal pro-brain natriuretic peptide (NT-ProBNP):a new marker of cardiac impairment.Clin Endocrinol 1997; 47:287-296.
  • [12]Richards AM,Nicholls MG,Yandle TG,Frampton C,Espiner EA,Turner JG,et al.Plasma N-terminal pro-brain natriuretic peptide and adrenomedullin:new neurohumoral predictors of left ventricular function and prognosis after myocardial infarction.Circulation 1998; 97:1921-1929.
  • [13]Harutyunyan MJ,Mathiasen AB,Winkel P,Gφtze JP,Hansen JF,Hildebrandt P,et al.High-sensitivity C-reactive protein and N-terminal pro-B-type natriuretic peptide in patients with stable coronary artery disease:a prognostic study within the CLARICOR Trial.Scand J Clin Lab Invest 2011; 71:52-62.
  • [14]Marwick TH.Adenosine echocardiography in the diagnosis of coronary artery disease.Eur Heart J 1997; 18 Suppl D:D31-D36.
  • [15]Sohn DW,Chai IH,Lee DJ,Kim HC,Kim HS,Oh BH,et al.Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function.J Am Coll Cardioi 1997; 30:474-480.
  • [16]Nagneh SF,Appleton CP,Gillebert TC,Marino PN,Oh JK,Smiseth OA,et al.Recommendations for the evaluation of left ventricular diastolic function by echocardiography.Eur J Echocardiogr 2009; 10:165-193.
  • [17]De Sutter J,De Backer J,Van de Veire N,Velghe A,De Buyzere M,Gillebert TC.Effects of age,gender,and left ventricular mass on septal mitral annulus velocity (E') and the ratio of transmitral early peak velocity to E' (E/E').Am J Cardiol 2005; 95:1020-1023.
  • [18]Ommen SR,Nishimura RA,Appleton CE Miller FA,Oh JK,Redfield MM,et al.Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures:a comparative simultaneous Doppler-catheterization study.Circulation 2000;102:1788-1794.
  • [19]Baykan M,Yilmaz R,Celik S,Orem C,Kaplan S,Erdol C.Assessment of left ventricular systolic and diastolic function by Doppler tissue imaging in patients with preinfarction angina.J Am Soc Echocardiogr 2003; 16:1024-1030.
  • [20]Pemberton CJ,Johnson ML,Yandle TG,Espiner EA.Deconvolution analysis of cardiac natriuretic peptides during acute volume overload.Hypertension 2000; 36:355-359.
  • [21]Rathcke CN,Kjφller E,Fogh-Andersen N,Zerahn B,Vestergaard H.NT-proBNP and circulating inflammation markers in prediction of a normal myocardial scintigraphy in patients with symptoms of coronary artery disease.PLoS One 2010; 5:e14196.
  • [22]Pan W,Wang LF,Yu JH,Fan Y,Yang SS,Zhou LJ,et al.Intracoronary nitroprusside in the prevention of the no-reflow phenomenon in acute myocardial infarction.Chin Med J 2009;122:2718-2723.
  • [23]Karaahmet T,Tigen K,Dundar C,Pala S,Guler A,Kilicgedik A,et al.The effect of cardiac fibrosis on left ventricular remodeling,diastolic function,and N-terminal pro-B-type natriuretic peptide levels in patients with nonischemic dilated cardiomyopathy.Echocardiography 2010; 27:954-960.
  • [24]Kasner M,Westermann D,Steendijk P,Gaub R,Wilkenshoff U,Weitmann K,et al.Utility of Doppler echocardiography and tissue Doppler imaging in the estimation of diastolic function in heart failure with normal ejection fraction:a comparative Doppler-conductance catheterization study.Circulation 2007; 11:637-647.
  • [25]Rivera M,Cortés R,Portolés M,Valero R,Sancho-Tello MJ,Martínez-Dolz L,et al.Plasma concentration of big endothelin-1 and its relation with plasma NT-proBNP and ventricular function in heart failure patients.Rev Esp Cardiol 2005; 58:278-284.
  • [26]Kien ND,White DA,Reitan JA,Eisele JH Jr.The influence of adenosine triphosphate on left ventricular function and blood flow distribution during aortic crossclamping in dogs.J Cardiothorac Anesth 1987; 1:114-122.
WanfangData CO.,Ltd All Rights Reserved
About WanfangData | Contact US
Healthcare Department, Fuxing Road NO.15, Haidian District Beijing, 100038 P.R.China
Tel:+86-010-58882616 Fax:+86-010-58882615 Email:yiyao@wanfangdata.com.cn