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Abstract
H
eart failure (HF) as the most important pathology of the new millennium, particularly in the elderly population. The growing interest for DD and for diastolic HF has been developed gradually from the advancement of non invasive imaging tools, above all Doppler echocardiography.
Natriuretic peptides are a family of naturally occurring counter regulatory molecules that represent a relatively favorable aspect of neurohormonal activation. They reduce cardiac preload by causing vasodilatation. They reduce sympathetic nervous tone and induce natriuresis.
In patients with diastolic dysfunction, BNP concentrations are high although some studies find that peptide levels are higher in patients with systolic dysfunction and patients with mixed systolic and diastolic dysfunction. Levels of BNP correlate with abnormality in indices of diastolic function.
In this study, 50 patients were submitted to clinical history and Echocardiographic examination. Patients were divided into two groups: 39 patients (group 1) who have mild diastolic dysfunction (Type I) and 11 patients (group 2) who had moderate to severe diastolic dysfunction (Type II-III).
Echocardiography was preformed after clinical history and examination to detect patients who had symptoms and signs of heart failure, those with any valvular heart disease, regional wall motion abnormalities, Ejection fraction < 55% and poor quality of echocardiographic study were excluded. The rest of patients were included. Then a sample of blood was drawn immediately after the Echocardiographic study and was transferred to Nasser institute hospital for analysis with Behring Elisa processor (BEP III) by a specific immunoradiometric assay for human BNP using a commercial kit (Shinoria).
In the present study, there was statistically significant increase in serum BNP level in patients with moderate to severe DD compared to patients with mild DD. There was also significant positive correlation between grade of DD and serum BNP level among studied cases.
from this study we conclude that BNP assay is a simple and available method to identify diastolic dysfunction. A cut of value of >80 pg/dl shows accuracy 54% with positive predictive value 50% and negative predictive value 81% so that serum BNP level is considered better negative than positive test with higher specificity than sensitivity and accuracy.