Force- and relaxation-frequency relations in patients with diastolic heart failure

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• 作者：Takashi Yamanaka ; Katsuya Onishi ; Masaki Tanabe ; Kaoru Dohi ; Kaoru Funabiki-Yamanaka ; Naoki Fujimoto ; Tairo Kurita ; Takashi Tanigawa ; Tetsuya Kitamura ; Masaaki Ito ; Tsutomu Nobori ; Takeshi Nakano
• 关键词：Alzheimer’ ; s disease ; Dementia ; Education ; Occupation ; Cognitive activities ; Exercise ; Cholesterol ; Statins ; Head trauma ; Prevention
• 刊名：American Heart Journal
• 出版年：2006
• 出版时间：November 2006
• 年：2006
• 卷：152
• 期：5
• 页码：966.e1-966.e7
• 全文大小：140 K

文摘

There is limited information regarding the clinical utility of amino-terminal pro–B-type natriuretic peptide (NT-proBNP) for the detection of left ventricular (LV) dysfunction in the community. We evaluated predictors of circulating NT-proBNP levels and determined the utility of NT-proBNP to detect systolic and diastolic LV dysfunction in older adults.

Methods

A population-based sample of 1229 older adults (mean age 69.4 years, 50.1 % women) underwent echocardiographic assessment of cardiac structure and function and measurement of circulating NT-proBNP levels.

Results

Predictors of NT-proBNP included age, female sex, body mass index, and cardiorenal parameters (diastolic dysfunction [DD] severity; LV mass and left atrial volume; right ventricular overload; decreasing ejection fraction [EF] and creatinine clearance). The performance of NT-proBNP to detect any degree of LV dysfunction, including mild DD, was poor (area under the curve 0.56-0.66). In contrast, the performance of NT-proBNP for the detection of EF ≤ 40 % and moderate-severe DD was strong with area under the curve of >0.90 regardless of age and sex; history of hypertension, diabetes, coronary artery disease; or body mass category. The ability of NT-proBNP to detect EF ≤ 40 % and/or moderate-severe DD was optimized by using age/sex-specific limits. Of “false-positive” tests, 88 % (124/141) were explained after considering cardiorenal determinants of NT-proBNP levels.

Conclusions

Amino-terminal pro–B-type natriuretic peptide is a suboptimal marker of mild LV dysfunction, but performs strongly as a marker of EF ≤ 40 % and/or moderate-severe DD in the community. Most subjects with a positive NT-proBNP test, using age/sex-specific cutoffs, had prognostically significant abnormalities of cardiac structure or function.