Clinical Meaning of the Ratio of Brachial Pre-Ejection Period to Brachial Ejection Time in Patients with Left Ventricular Systolic Dysfunction

Abstract

An increase in the ratio of the brachial pre-ejection period to brachial ejection time [pre-ejection period (PEP)/ET] is correlated with a decrease of left ventricular ejection fraction (LVEF). The current study was designed to test the hypothesis that the change value (Δ) of PEP/ET is a useful indicator of Δ LVEF in patients with left ventricular systolic dysfunction.We consecutively enrolled 104 patients with left ventricular systolic dysfunction (LVEF < 45%). PEP/ET, B-type natriuretic peptide (BNP), and LVEF were evaluated at baseline and at 6-month follow-up. Compared with the baseline measurements, the 6-month values of ΔLVEF, ΔBNP, and ΔPEP/ET were 9.8% ± 9.0% (from 36.3% ± 9.2% to 46.3% ± 12.5%, P < 0.001), -168.5 ± 255.4 (from 271.4 ± 282.5 to 104.1 ± 129.6, P < 0.001), and -0.060 ± 0.069 (from 0.413 ± 0.097 to 0.358 ± 0.079, P < 0.001), respectively. There were significant correlations between LVEF and PEP/ET and between LVEF and BNP in both the initial (r = -0.316, P = 0.001 and r = -0.598, P < 0.001, respectively) and 6-month follow-up (r = -0.307, P = 0.003 and r = -0.701, P < 0.001, respectively). The Steiger's Z test showed that BNP had a significantly stronger correlation with LVEF compared with the correlations between LVEF and PEP/ET in both the initial and 6-month studies (Z = 2.471, P = 0.013 and Z = 3.575, P < 0.001, respectively). There were also significant correlations between ΔLVEF and ΔPEP/ET (r = -0.515, P < 0.001) and between ΔLVEF and ΔBNP (r = -0.581, P < 0.001); however, there was no difference between the correlations for ΔLVEF and ΔPEP/ET versus ΔLVEF and ΔBNP (Steiger's Z = 0.600, P = 0.545).In patients with left ventricular systolic dysfunction not only ΔBNP but also ΔPEP/ET could be a simple indicator of predicting change of LVEF.

Possible Mechanisms Underlying Elevated Serum N-Terminal Pro-Brain Natriuretic Peptide in Healthy Japanese Subjects

“…Moreover, in 2009, we also excluded 196 employees with serum NT-proBNP >125 pg/mL and PEP/ ET >0.43 or not measured at all. Based on Reant et al and Park et al,11,12 we excluded subjects with PEP/ET >0.43 given that this indicated cardiac systolic dysfunction. In other words, we excluded these subjects who had already developed HF or cardiac systolic dysfunction.…”

Novel Pulse Waveform Index by Ambulatory Blood Pressure Monitoring and Cardiac Function

“… 1 , 2 , 3 Although international guidelines recommend examinations by echocardiography and catheterization for the evaluation of cardiac function, 1 , 2 these are highly specialized examinations in clinical practice, and there have been several studies of methods to estimate cardiac function using the blood pressure (BP) pulse wave instead. 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 Although the association between the BP pulse waveform index and cardiac function in patients with HF has been investigated, the majority of those investigations used an invasive method to evaluate the BP pulse waveform or were conducted in a laboratory setting. 7 , 10 , 12 , 13 , 14 There are few data about the association between the BP pulse waveform and cardiac function in HF patients in an ambulatory setting.…”