Accuracy of Tissue Doppler Echocardiography in the Emergency Diagnosis of Decompensated Heart Failure with Preserved Left Ventricular Systolic Function: Comparison with B‐Type Natriuretic Peptide Measurement

Abstract

Tissue Doppler echocardiography is accurate for predicting decompensated HF with preserved LV systolic function and may be used as a diagnostic complement to inconclusive BNP level in this setting.

Combining tissue Doppler echocardiography and B-type natriuretic peptide in the evaluation of left ventricular filling pressures: Review of the literature and clinical recommendations

“…In 122 patients hospitalized with dyspnea and suspected CHF (46), we demonstrated that BNP 250 pg/mL or greater and a mitral of E/Ea 15 or greater were comparably accurate (80%) in diagnosing clinical CHF using the Framingham criteria. In 78 patients with confirmed diastolic heart failure (LVEF 45% or greater) compared with 38 patients with noncardiac dyspnea, BNP greater than 146 pg/mL (sensitivity of 90% and specificity of 76%) and the E/Ea greater than 11.5 (sensitivity of 80% and specificity of 94%) were similarly accurate for predicting decompensated CHF, and the E/Ea added independent additional information to clinical judgment and BNP (47). In 108 patients referred for echocardiography (48), although BNP levels correlated to E/Ea, using either index alone was inferior to combining them for the estimation of LV filling pressure.…”

Comparison of B-type natriuretic peptide with left atrial enlargement by echocardiography for the diagnosis of new-onset congestive heart failure with a preserved left ventricular systolic function in the setting of longstanding hypertension

“…Further, specificity and positive predictive value of this biomarker for the diagnosis of HFPSF were not reported in that study. Two other recent works have addressed the usefulness of basal BNP concentration for the diagnosis of HFPSF in small, heterogeneous patient populations, and yielded promising results [5,6]. Nevertheless, several confounding variables such as age, gender, myocardial ischemia and LV hypertrophy are acknowledged to potentially influence BNP levels and studies that focus on the accuracy of BNP in the setting of longstanding hypertension, which accounts for the largest percentage of patients carrying a diagnosis of HFPSF, are desirable.…”

“…Recently, B-type natriuretic peptide (BNP), a neuro-hormone that is secreted by ventricles in response to myocardial stretch and volume overload, has emerged as a simple, valuable marker of global myocardial dysfunction and filling pressures, and is subsequently proposed as the first-line diagnostic complement to the clinical syndrome of heart failure (HF) [3]. Some clinical studies have produced convincing evidence that this biomarker is helpful in the setting of HFPSF [4][5][6], however its diagnostic accuracy has not been specifically established in the setting of HFPSF related to longstanding hypertension, which is likely to be characterized by specific pathophysiologic mechanisms [7][8][9]. We aimed to compare the usefulness of BNP to the left atrial enlargement, a well established marker of global myocardial dysfunction in the setting of hypertensive heart disease [9], in the diagnosis of acute HFPSF related to hypertension.…”

Accuracy of bedside tissue Doppler echocardiography for the prediction of in-hospital mortality in elderly patients with acute heart failure with preserved left ventricular systolic function. Comparison with B-type natriuretic peptide measurement

“…Besides age, several prognostic variables have been identified in acute HF syndromes with preserved LV systolic function, including symptoms at rest, systolic blood pressure, renal failure and B-type natriuretic peptide (BNP) [1,3]. Currently, bedside tissue Doppler echocardiography offers the ability to provide additional diagnostic information over the clinical judgment and BNP measurement in patients with preserved LV ejection fraction and suspected congestive HF [4,5]. The aim of the present study was to assess how well does tissue Doppler echocardiography predict in-hospital outcome in elderly patients hospitalized for acute congestive HF with preserved LV systolic function.…”

“…Three consecutive cycles were averaged for each Doppler parameter in sinus rhythm and 5 consecutive cycles in arrhythmia. Septal E/Ea ratio was used as a simple and reliable noninvasive surrogate for pulmonary capillary pressure regardless of rhythm (observer variability of 4 to 7%) [4][5][6].…”